medical anthropology: healing practices in contemporary sikkim

CHAPTER 7

Medical Anthropology:Healing Practices in Contemporary Sikkim

Veena Bhasin

INTRODUCTION

The present study deals with the healingpractices in contemporary Sikkim and thetransformations that have occurred and areongoing in traditional healing among culturalminorities in Sikkim. Concept of disease andsickness, the differet methods of treatment, theofficial health policies over the years among tribesof North Sikkim have been taken into account.The study focuses on how and why thetraditional medical knowledge is still persistingamong the Lepchas and Bhutias of North Sikkim.It focuses in particular on their ethno botanicalknowledge and use of medicinal plants, theirconception and perception of ill-health and ritualhealing mechanism. The present study aims tocontribute to the subject of medical anthropologyby looking at the combination of use of popularand home-based remedies, herbal, religioushealing, spiritual practices and biomedicaltreatment among tribal communities in NorthSikkim. It does so by focusing not only on thedifficulties tribal communities might encounter inintegrating into the system but concentrates alsoon the multiple ways people deal with physicaland mental health problems.

Sikkim, a small mountainous state haswitnessed great changes in its political structure,social structure, economic life and cultural valuesduring the past hundred years. Sikkim was akingdom ruled by Chogyalas. It remained akingdom for long and a protectorate state of Indiabefore its merger in 1975 as its 22nd state. Theprocess of change was quickened from differentdirections, resulting in multiform ethnic mix.Covering 7,096 square kilometres, the state is 113kilometres long and some 64 kilometres wide.Sikkim contains with its borders a variety of non-tropical and geographic environments from thelow snow-free outer hills to the high peaks withpermanent snow and glaciers. Hills ranging from300 metres above the sea level to 7,000 metresadorn the state. The varying altitude results in aclimate that varies from sub tropical to alpine.Sikkim has a rugged topography and flat pieces

of land are rare to meet with. The high mountainsthat define its beauty also create barrier to efficientagriculture.

The health-sickness process is a tangibleveracity for all people all over the world. Healersacross the world might work on different premiseand follow diverse practices however the maingoal is to cure sickness and maintain good health.This cognitive development is part of the culturalheritage of each population, and from it empiricalmedical systems have been formed, based on theuse of natural resources. All cultures have sharedideas of what makes people sick, what makes welland how people can maintain good healththrough time. These beliefs help people makesense of the world around them. Both lay peopleand health professionals tend to combine theirsociety’s health belief systems with knowledgegained through first hand experience. Anindividual’s healing beliefs, which are embeddedin their worldview, is utilised by the individual toconceptualise what is considered as problematic,and provides rationale for the problem. Theseindividual models of the belief are often referredas ‘explanatory model’ (Kleinman, 1980).Explanatory models provide a framework withinwhich individuals sort through and make senseof illnesses, injuries and disabilities.

Medical systems are an integral part of allcultures, which affect the health status of thepeople. The medical system includes the totalityof health knowledge, beliefs, skills and practicesof the every group. Every culture has developeda system of medicine, which stand an enduringand shared relationship to the existing worldview.The medical behaviour of individuals and groupsis understandable discretely from commoncultural history.

The medical systems of all groups, howeversimple some may be, can be divided into twomajor categories: (i) disease theory system, and(ii) a health care system.

A disease theory system embraces beliefsabout the nature of health, the cause of illness,and the remedies and the other curing techniquesused by doctors. In contrast, a health care system

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concern with ways employed by the society todeal with sickness and maintenance of health.The knowledge of disease theory and health caresystem of a society enables us to cope morewisely, more sensitively while introducing newmedical system among people who have knowntraditional system previously. Traditional diseasecausation ideas often persist long after westerninnovations in health care have been introduced.

Basically, there are two systems of health carein the developing world: one is traditional andthe other is Western in derivation. The concept oftraditional medicine is a conventional term usedby medical scientists to refer to the empiricalmedical systems used in different cultures all overthe world. Traditional medicine include all kindsof folk medicine, unconventional medicine andindeed any kind of therapeutic method that hadbeen handed down by the tradition of a commu-nity or ethnic group. The medical traditions inthe traditional system are diverse in their historicalbackground, theoretical logic and practices, theircontemporary social realities and their dynamics.It does show that a large country like India, withdiverse cultures and traditions, should be rich intraditional medicine. Although there are sharedgeneralities, each society has developed acomplex medical system that encompassesideological concepts and practical therapies, andhas also developed the specialists that know howto apply them.

In colonial times, authorities frequentlyoutlawed traditional medical systems. In post-colonial times the attitudes of biomedicalpractitioners and government officials havemaintained the marginal status of the traditionalhealth care providers despite being the fact thatamong rural people in the developing countriesthe traditional medicine serves an importantfunction. Organisational relationship betweenmodern and traditional medicine can come in tobeing in four different ways—monopolistic,tolerant, parallel and integrated. Factorsinfluencing the status of traditional medicine inpolicy making are economic, cultural, nationalcrises (war and epidemics) and internationalpressure to conserve traditional knowledge,which all otherwise will disappear because of lackof documentation. Indian Medical Council Actformally established the traditional system—Ayurvedic, Unani and Siddha-as official compo-nents of national health care in India. In Ladakh,a traditional medical system Amchi has been

incorporated into health planning. It is based onTibetan medical system, and is holistic, costeffective and locally available (Bhasin,1997) .

In the traditional medical systems, medicaltraditions partly cover other sectors of social life.The beliefs and practices of health, knowledgeand its transmission, refers as much to thereligions and the therapeutics, as to the economic,and the political fields. It forms a coherent whole,the object of which is to explain, to prevent, torelieve or heal what stems from misfortunes andcause illness. Traditional medical systemstherefore cannot be studied exceptionally.

In contrast to traditional health care system,the official health care system is based onWestern science and technology. In keeping withthe scientific tradition, its practitioners makeevery effort to separate themselves from broadersocial and cultural concerns and influences.Western medicine has influenced large regionsoutside the west markedly in Asian countries.

Traditional medical traditions have continuedto co-exist with biomedicine. The term “TraditionalMedicine” or “Traditional Systems of HealthCare”, refers to long standing indigenous systemsof health care found in developing countries andamong indigenous populations. These traditionalmedical systems view humanity as being intimatelylinked with the wider dimension of nature .TheWorld Health Organisation has referred to thesesystems as “holistic”- i.e., “that of viewing man inhis totality within a wide ecological spectrum, andof emphasising the view that ill health or disease isbrought about by an imbalance, or disequilibriumof man in his total ecological system and not onlyby the causative agents and pathogenicevolution”. The treatment strategies used intraditional systems of health include the use ofherbal medicines, mind/body approaches such asmeditation, and physical therapies includingmassage, acupuncture and exercise programmes .These are low-cost, locally available treatments,which according to WHO are utilised as thesource of primary health care by 80 % of theworld’s population. At present, more than 20centers around the world collaborate in the WHOTraditional Medical Programme.

In the traditional medical systems theknowledge of health and illnesses is not codified,but is widely shared between users and practi-tioners (Press, 1978: 72). Traditional medicalsystems enunciate theories of disease aetiologyand arbitration within a larger cultural framework

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of moral, ethical, religious, and supernaturalconcerns. Religious and charismatic healingbelongs to the folk medical system becausetherapy is affected by means of prayers to, andfaith in a supernatural being. A relatively modernterm, folk medicine has come to mean the care ofthe sick by unlicensed healers, including thosewho practice herbal and magical medicine. Thetraditional health system in India comprises oftwo social streams - local health beliefs andpractices relying on instantaneously availablelocal resources; and the codified organisedknowledge based on theoretical foundations(Ayurvedic, Si Siddha and Unani). Traditionalfolk practitioners include: herbalists, bonesetters,traditional birth attendents, spiritual healers andother specialist. It is frequently thought thattraditional medicine only deals with natural andherbal cures.

Ethnic medical literature has defined two typesof Traditional Health Systems-the naturalisticsystem and personalistic system. The naturalis-tic systems have been described as those, whichare natural sciences with controlled investigationof documented materia medica having acomprehensive theoretical framework againstwhich treatments are tested and new treatmentsare generated. The personalistic traditions havebeen described as these which have theknowledge of healing, possessed by an individualeither selected by someone in the community orby a process of divine revelation, or by revelationof some form.

The state-supported modern medical system,which tends to be synonymous with amonopolistic medical “establishment” and adoctor-dependent, hospital-based, curativehealth care model, does not generally recognise,cooperate with, or adjust to the traditional medicalsystems. The two exist side by side; yet remainfunctionally unrelated in any organisationalsense. The combined use of both types ofexpertise provides an optimal broad-spectrumresponse to health problems. “Medical pluralismoffers a variety of treatment options that healthseekers may choose to utilize exclusively,successively, or simultaneously” (Stoner, 1986:4). People may try a variety of practitioners andtreatments, from the same or different systems,until a cure results. In many societies thecontinuing process of negotiation takes place aspatients seek therapies and aetiologies consistentwith their understandings of illness (Morsy, 1993).

Patients may accept some aspects of the scientifichealth care system as presented to them by agovernment physician, and they may supplementthis with information gathered in consultation withtraditional healers. The systems differ in availa-bility, quality of care, levels of technology, andsocial adaptability; yet, ideally, both are intendedto serve the same population in need.

The relationship between folk and classicaltraditions in India is symbiotic. There is strongsimilarity in underlying theory and worldviewexpressed at the level of theory of causation ofsome diseases. There is also a striking commonground for technical terms that are used by folk-healers and traditional practitioners such asvaata, pittaa, vaayu, kapha, ushna, sheetala. Allthese terms form part of the knowledge of folkpractitioners and the households. The classicaltext of Ayurveda also mention about the folktraditions and healers. In Charaka Samitha, it ismentioned that “goat herds, shepherds,cowherds and other forest dwellers possessknowledge about herbs and its use in sickness”(shaloka-120-121). Likewise it is mentioned in-Surutha Samhita that “one can know about thedrugs from the tapasvis (an ascetic), hunters,those who live in the forest and those who liveby eating roots and tubers” (Chapter-36,shaloka).

The traditional healer, as defined by theW.H.O. (1976), is a person who is recognised bythe community in which he lives as competent toprovide health care by using vegetable, animaland mineral substances and certain othermethods based on the social, cultural and reli-gious background, as well as on the knowledge,attributes and beliefs that are prevalent in thecommunity, regarding physical, mental and socialwell-being and the causation of disease anddisability.

Traditional or local medicine still remains animportant source of medical care in thedeveloping countries even though it is notofficially recognised by the government healthcare programs (Jaspan, 1969; Kleinman, 1980). Itpersists in urban as well as rural settings despitethe availability of allopathic health services.Studies have shown, however, that its generalpersistence is decreasing in importance overgenerations, particularly among socially isolatednuclear families. In traditional medical systemsworldwide, afflictions that beset body and mindcan be explained in both naturalistic and super

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naturalistic terms. When a wound does not heal,when a sickness does not respond to treatment,and when the normally expected and predictabledoes not happen, other explanations beyond theorganic are sought (Scheper-Hughes, 1978).

Herbs were the first medicines used by prehistoric man. They are, therefore, part of everycultural tradition and have helped the develop-ment and growth of herbalist. The World HealthOrganization (WHO) estimates that 4 billionpeople, 80 percent of the world population,presently use herbal medicine for some aspect ofprimary health care. Herbal medicine is a majorcomponent in all indigenous peoples’ traditionalmedicine and a common element in Ayurvedic,homeopathic, naturopathic, traditional oriental,and Native American Indian medicine.

AREA AND PEOPLE

Sikkim

Sikkim is a multi-linguistic, multi-religious andmulti-ethnic state. Historic events have playedtheir part in creating such a mosaic. The Lepchasare considered the original inhabitants. In theseventeenth century (1641), they came in contactwith the Tibetan Bhutias, resulting in theTibetisation of the Lepchas. British contact (1884-85) encouraged Nepali (a generic term thatinclude many castes and tribes), immigration aslabour was required for construction of roads andextension of agriculture in the 19th and early 20th

century. The ethnic scene of Sikkim changedrapidly with the multiplication of the number ofNepalese. The impact of this migration has beengreat and has social and cultural ramifications.Over the time, in Sikkim, the relationship betweenthe established Buddhist Sikkimese populationand the Nepali Hindus has led to rivalry andconfrontation culminating in the dethronementof the Buddhist monarch and the incorporationof Sikkim into the Republic of India. Foradministrative purposes, the state is divided into 4 districts- South, North, East and west.

Population

With only 540,000 inhabitants, Sikkim is theleast populated state in India. The Lepchas areconsidered the original inhabitants of Sikkim andDarjeeling Hills. (Darjeeling hills were part ofSikkim and were annexed by British India in 1835)

According to the 1891 gazetteer of Sikkim theNepali constituted 56 percent, the Lepchas 19percent and the Bhutias 16 percent of thepopulation. A more than hundred years later, theNepalis have grown to 75 percent; the Lepchashave declined to 9 percent while the Bhutiapopulation percentage remained more or less thesame. In June 1978, the Lepchas, Bhutias, Sherpasand Doptapas were notified as Scheduled Tribes.The Kami, Damai, Lohar, Majhi and Sarki havebeen classified as Scheduled Castes.

Except for North Sikkim, wherein certaingroups of Lepchas and Bhutias are territoriallybound, Bhutia, Lepcha, and Nepali groupsbelonging to specific religions, races andlanguages are found scattered in various parts ofSikkim. All these groups are characterised byspecific ecological adaptations, as well as by typesocial organisation of the region. Most groupsare culturally adapted to certain altitudes wherethey live which have been a barrier to overallpopulation mixture.

The north Sikkim is more tradition fervent thanrest of the Sikkim. The inhabitants of the northSikkim have been leading a sheltered life becauseof geographical isolation as well as officialrestriction of settling of outsiders in Dzongureserve and Lachung and Lachen. A Lepchareserve in Dzongu zone, which was a privateestate of the queen, was created to preserve theirsocial homogeneity. Even if no reserve likeLepchas was created for Bhutias of Lachung andLachen, they did have some degree of seclusionreinforced by political and ecological factors. Theresidents of these areas have been leading asecluded life and have continued to live andfunction in a traditional life style in accordancewith their respective ethics and religious life style.In harsh and extreme climates and terrain, peoplealways have symbiotic relationship with thenature (For details see Bhasin, 1989).

A wide range of crops are cultivated in agro-climatic zones, including upland rice, vegetables,pulses, potato and ginger. In North Districtsizeable forest areas have been converted for largecardamom cultivation, which grows under shade.Cardamom and ginger are grown commerciallyand make up Sikkim’s main export. Each villagehas different endowments of various types oflands and diverse patterns of access to publicand common lands. As the slopes are steep, mostagriculture is practiced on narrow terracedbenches. Sikkim is subjected to torrential


monsoon, ensuing in rapid run off on the slopescausing landslides and flooding in the riverbottoms.

There are two main periods in Sikkimesehistory—pre merger and post merger. The pre-merger Sikkim was certainly different from presentday Sikkim. There was strong religious andcultural influence of Tibet on Sikkim. However, itcan not be said that Tibetan system wastransplanted on to Sikkim. Lepchas, the originalinhabitants of Sikkim were animists. The Bhutiaswho emigrated from Tibet were followers ofLamaist Mahayana Buddhism diffused with Bonanimists spiritualistic traits. Lamaism, Hinduismand spirit worship are practiced by different ethnicgroups inhabiting Sikkim, however it is difficultto classify them accurately. The Sikkim containsgompas of three major sects of Lamaist Buddhism-Nyingmapa, Kargyupa and Gelugpa. The‘Gompas’ as a rule, are merely temples (hlakhang)with one or more lamas engaged in ministering tothe religion

There are functional Local Health Traditionsin vogue in different parts of the Sikkim state.Despite the fact that north Sikkim is traditionfervent, specific areas like Lachung, Lachen andDzongu in and around the KanchenjungaBiosphere Reserve are more conventional. Inother villages also, many people are well-informedabout medicinal properties of plants and theirutilisation in curing of diseases. The people ofSikkim, by tradition have adapted themselves tothe vagaries of nature by evolving intricate socialand cultural mechanisms. Their medicinalpractices too were woven within thesemechanisms. The earlier inhabitants of Sikkimpracticed shamanism, which was prevalent underthe name bon. In due course of time, the amchiunder the influence of the Buddhism establishedthem in Sikkim, as the original inhabitants(Lepchas) had converted to Buddhism. Since theamchi were also religious people, they wereaccepted readily.The tantric form of religion andmedicine as popularised by Guru Padama-sambhava mingled with Tibetan Buddhism.

Lepchas of Dzongu

Sikkim grew into a plural society because ofthe migrations of Tibetan Bhutias and theNepalese. The British occupation of Sikkimpromoted an influx of the Nepali labour force, andgradually these people outnumbered the

indigenous population of Lepchas. As aconsequence, the Lepchas were pushed furtherinterior, except those who because of hypergamyand other relations adjusted with Bhutias. Forprotecting the land and identity of the Lepchas ,the Maharajah of Sikkim converted one of theroyal estates into a Lepcha reserve-Dzongu. Thiswas an inaccessible tract of land with a scantypopulation. Lepchas here subsisted by collectingnatural forest produce, such as roots, tubers,leaves, grasses, fruits and herbs. The foodgathering was supplemented with shiftingcultivation, where large tracts of land were clearedby burning and crops were grown with the helpof simple implements. Each plot was used for oneor two successive years, and then abandoned.The main aim of Lepcha reserve was to preservethe social homogeneity. Outsiders need permit tovisit Dzongu. Even the other ethnic groups ofSikkim need to secure a special permit from thegovernment to enter Dzongu. Only the Lepchasof the reserve are allowed unrestricted entry.

However this served only one purpose—theuse of land for Lepchas exclusively—butotherwise their culture was being constantlymodified by external factors. From 1940 onwards,Lepchas of Dzongu reserve gradually abandonedhunting, gathering and slash and burn cultivationof dry rice and started farming. From primitivestage of cultivation, Lepchas developed agricul-ture, replacing shifting cultivation by more effi-cient methods of terracing, ploughing and irriga-ting fields. Entire mountainsides were convertedto cardamum and terraced for the cultivation ofirrigated paddy. The cardamum cash crop notonly brought Dzongu Lepchas within Sikkim’smarket economy but helped create a surpluswhich could among other things be invested inreligion. They visited nearby markets for sellingand buying. Through contact with outsiders, theelements of change and innovations enteredDzongu and were adopted. However the processof change was rather slow. At the time of fieldwork (1981-83), Dzongu was not well connectedto the district headquarters-Mangan, on theNorth Sikkim highway. At present restricted eco-tourism and trekking tours operate in the area,Dzongu is still a reserve area and outsiders cannotpurchase land or property in the area nor canthey stay there longer than the specified period.A poorly maintained jeep road connects Dzonguarea to Mangan. Since 1970, with the spread ofeducation, some changes have taken place, but

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the essential structure has remained the same.Lepchas of Dzongu linguistically belong to theTibeto-Burman group having their owndistinctive language, script and literature .Lepchasociety is divided in to named putso (clan). Lepchaclans claim to have mythical connections withparticular mountain peaks which they worship astheir deity. Thus the mountains Simvo, Siniolchuand Kanchenjunga find prominence in the Lepchaculture. They use patrilineal descent to determineinheritance and group membership. However forstrengthening social relations, alliances andnetworks of support depend on matrilineal kins.Although the household is smallest unit, there ismutual-aid group-lobo, based on reciprocity,consisting of neighbours and/or kinsmen, mostlyon residential and customary lines to help co-villagers in need. They practice monogamy,polygyny and polyandry form of marriage andpatrilocal residence (For detail see Bhasin, 1989).

Bhutias of Lachen and Lachung

Like Dzongu, the valleys of the Lachen andLachung were also the private estate of the Queenat the time of Campbell’s visit. It is mentionedthat valleys were under the rule of Maharaj Kumarof Sikkim (Sikkim,1912: p.2). The Bhutias of NorthSikkim are a tribe of agro-pastoral transhumantswho migrate in the high altitude valleys of NorthSikkim. The areas which they customarily inhabitare the two river valleys of Lachen and Lachung,situated on the banks of tributaries of Tista-Lachenchu and Lachungchu, respectively. TheBhutias of Lachen and Lachung are migrants fromBhutan. Though Bhutanese in origin, they weremuch influenced by Tibetan culture. Lachen andLachung have their own traditional localgovernment system. The provisions of the 1965Panchayat Act are not extended to this area.They have preserved their traditional form ofDzumsha and Phipun administration. These areasare especially reserved ones where the right tosettle or own land is not allowed to outsiders,irrespective of their ethnic origin. The Lachenand Lachung area has a special status with regardto settlement, land revenue and local adminis-tration. The Bhutias of Lachen and Lachung havecommunal forest/pastures and agricultural landwith family ownership of land but with strongcommunity regulation of the land usage. Thevillage is an important land holding unit. The saleof land to outsiders is forbidden by the village

council-Dzumsha. The whole system ofdistribution of land is known as sago. In this formof land tenure, the communal authority overridesany claim the state might extend on internalsovereignty or state lanlordism. Communitymembership entails mandatory participation in anumber of domestic rituals, as well as ceremoniesof territorial and ancestral deities. These ritualshelp ensure the health, fertility and prosperity ofthe individual, the land and the household.Although these ritual obligations were originallyheld to insure community membership but it alsoentitled them labour and help in case ofemergency. Among Bhutias, the household is thesmallest and most important unit of productionand consumption. However, in cases of need,existing group structures- chuchi, larger than thehousehold and smaller than the busti are available.Chuchi are the mutual aid groups based onreciprocity, consisting of neighbours and/orkinsmen, mostly on residential and customarylines. Though these are informal groups, violationof its rules may lead it to formal level. At presentthe Bhutias are polyandrous, polygamous andmonogamous. There are no hard and fast rulesabout it.

With the closure of border in 1962, severalchanges took place in the area. Militaryencampments, supply bases, and defence postswere set up in the Northern border area. The lossof pastures in Tibet made Bhutias to shift from apastoral and trading economy to agricultural andsmall scale horticulture and wage-earningeconomy. But they can not depend on agriculturealone, because of the scarcity of arable land inthe near vicinity of permanent villages and othersenvironmental features restrict land use. Atpresent, Lachenpas and Lachungpas are prac-ticing high altitude farming and animal husbandry.They raise yak, dzow, sheep, goats, horses andmules. Pastoralism is still a major economicstrategy, but agricultural activities are also carriedon along. They move above’and below the rivervalleys and exploit the grazing lands and arableland for cultivation along the valleys andsurrounding areas (For details see Bhasin,1989,1993, 1996, 1997).

Religion

Lepchas practice two contradictory religionsside by side- mun religion (spirit worship) as wellas Lamaism. Lepchas’ mun religion is a communal


religion wherein all Lepchas have to participatein cults of family, putso (clan), busti (village) andcommunity. It is a part of their obligation as aLepcha towards their protective deities and spiritsof the area. The link with the community becomesvery strong in cases where the ethnic –religiousidentity itself happen to be at the risk of beingput out, hence ensues the strong solidarity asseen among Lepchas ,factually surrounded byother dominant religious customs. The populationof Sikkim is predominantly Hindu (68 percent),Buddhist constitutes 27 percent and Christianscomprise 3 percent. The boundaries betweenindigenous Lepcha-Bhutia minority and theperceived Nepali migrant majority are beingstrengthened by religious differences

The main function of Lepcha religion is tohelp people to cope with the problem of sufferingand provide means for getting relief from thedistress. The popular religion of Lepcha is basedon demonolatry. Among the Lepchas theconception of god is vague, and apparently, ithad not attained maturity when it was supersededby Buddhism. According to Lepchas the world ispeopled by good spirits-rum; and the evil spirits–mung. Trees, rivers, rocks and other naturalobjects are the homes of these spirits. However,Lepchas propitiate only the spirits and not theactual objects. That which cannot be explainedpragmatically is considered the actions ofsupernatural and the peoples viability to copewith such acts form the basis of religious system.Lepcha rituals primarily serve to insure that aperson will have a long and healthy life and sufferfew misfortunes. Lepchas perform curing andpurification rites.

The central religious roles are traditionallyoccupied by bonthing and mun, who bothfunctions as shamans. The bonthing is always amale, a mun mostly a female. In the Lepchashamanism, ‘mun’ and ‘bonthing’ is an exorcistwho performs rituals and sacrifices for thecommunity. The mun worships two super-naturals- Hit rum and De’rum, who are consideredto be ancestral gods, who look after the deadLepchas. Bonthing presides at recurring religiousceremonies and seasonal festivals and may treatacute illnesses. The role of bonthing and mun isinherited within the family or putso, one of themembers being chosen for this by thesupernatural that protect and at times alsopossess him. With the help of their guardiandeities the bonthing and mun are able to avert

and counteract the influence of malignant spirits,cure illness etc. It is possible for a bonthing todevelop into a mun, in Sikkim such healers areknown as padem. After the death, mun are buriedand conducted to heaven by a mun. If not buried,an angered mun transforms herself into Sabdokmung and cause discomfort to relations. Lepchasperform numerous ceremonies that are facilitatedby bonthing-the priest. There are year roundceremonies viz. cherim, a number of rumfaats(ceremonies) wherein deities are pleased beforeundertaking any activity in mountains, rivers orforest.

Sikkim converted to Lamaism around 1641.Lamaism is a mixture of several elements .The chiefelement is Mahayana Buddhism, with anadmixture of tantric Hinduism and Tibetan Bonreligion. Bon is the indigenous, pre- Buddhistreligion of Tibet, Bhutan, Sikkim and China, whosemembers are known as Bonpo. After the entry ofBuddhism in Tibet in the 7th century, bon wasabsorbed and transmuted so that modern bonclosely resembles Buddhism though sometraditions and practices of animal sacrifice havepersisted from it in some areas. The majority ofLepchas became Buddhists after the migrationand settlement of Bhutias into Sikkim. However,they continued practicing shamanism, theirindigenous religion along with Buddhism. Theform of Buddhism prevalent here is not of mostspiritual type. Lepchas in need do not pray to aBuddhist deity, but to the spirits of the land asthey believe that spirits, witches and ghosts actas both mischief makers and deliverers ofdisasters. They worship the spirits of land andwater for good health, ample rains, excellentharvest and prosperity. The craving for protectionagainst malignant gods, spirits and demonscauses the people to pin their faith on charmsand amulets and to erect tall prayer flags, withstrings of flag lets, which flutter from house-tops,bridges, passes and other places believed to beinfested by evil spirits. Prayers hang uponpeople’s lips. The prayers are chiefly directed todevils, imploring them for freedom or release fromtheir inflictions, or plain naïve requests for aid inobtaining the good things of life. The mun/bonthing and the Lama do not contradict eachother but co-exist as religious specialists. Themun religion and Lamaism have become sointerconnected that many Lepchas ceremoniesare concurrently performed by Buddhist Lamasand Lepcha bonthings, each to perform their own

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rituals. The addition of Lepchas sacred mountainsand landscapes into the Buddhist pantheon madeeasy the indigenisation of the Bhutias and thecoexistence of shamanism and Buddhism inSikkim. The Lamas offer prayers to the Buddhistgods and goddesses and propitiate the protectivedeities of the land while mun/bonthing appeaselocal spirits and offer sacrifice for the bettermentof community. The main characteristics of theLepcha religion are divination, possession,exorcism’ propitiation and expiation; thus pointingtowards the total integration of the mun andLamaism. The converted Lepchas acceptedscriptures, mythology, view of priesthood andsocial organisation but have rejected individualethics (for details see Gorer, 1938 ). Buddhism isfounded on literacy; the Lepchas were illiterate,and although a few of higher ranking priests hadlearned to read some sacred books, this skill hadnot penetrated the general stratum of Lepcha. Thepriesthood of Buddhism is founded on anelaborate pyramid of rank hierarchy, culminatingin Dalai Lama, a sacred parallel to a monarchialfeudal society. The Lepchas have accepted thishierarchical principle for religious purposes;however it has no influence on their secular life,which is basically egalitarian. Lepchas alsoworship people of Mayel (a mythical countryvisited by people of earth in olden times) whileperforming rituals at the time of sowing andharvesting of dry rice and millet.

In Lepchas society, the gompa (monastery)complex is located in the busti and the Lamas andlaity have a patron-client relationship. There aresome patches in the Dzongu forest that arededicated to ancestral spirits or deities as a socio-religious practice by Lepchas. In the Buddhistphilosophy such a practice represent theecological wisdom of the local group. The sacredlandscape of Tholung gompa of Dzongu ,situated at altitude of 8,500feet in an uninhabitedtrack of 14 kilometre square of mountainousforests. The Tholung gompa was first built in thereign of Chogyal Chakdor Namgyal in the early18th century. It contains rare and valuablescriptures and artifacts of other monasteries thatwere brought here for safety during the invasionof Sikkim by the Nepalese during the late 17th andearly 19th century. Once every three years in themonth of April, the relics are displayed in thegompa complex for the public. Beyond Tholunggompa, there are some sacred caves and sacredspring. Traditionally Lepcha lamas and mun/

bonthing performed special rituals to ensure thecontinuity of the royal lineage and to propitiateMt. Kanchenjunga who is regarded as theguardian deity of the Lepchas and the kingdomof Sikkim. Only a few select lamas, who look afterthe daily worship of protective deities, staynearby. This gompa is situated in land- slide pronearea. However, the local inhabitants perceive thisas the result of the anger of the Tholung deitiesand Sikkim’s other protective deities.

Lingthem monastery in Dzongu was built in1855 belonging to the sub sect Lhatsun-pa of thesect Nyingma-pa ‘Red Hat’. Mahayana Buddhismintroduced into Sikkim was the old unreformedsect which preserved in its religious practicesmany customs originating from the Bon, the Pre-Buddhist Bon faith of Tibet. Mahayana Buddhismis known as Tibetan Buddhism or Lamaism. Itcontains mystical occult elements. In the earlytwentieth century, western scholars used shama-nism to allocate the tradition of Bon as a colossalgroup that includes a large assortment of religiousphenomena. Sorcery, divination, black magic,fetishism, demonolatry, exorcism, ecstatatictrance, spirit possession, and various other super-natural powers were considered the elements ofBon shamanism. In the present study in NorthSikkim, Shamans have been understood inrelation to Buddhist lamas having social andreligious roles. Lepcha-Bhutia shamans aredistinguished as spirit mediums “whose‘deconstuctive voices’subvert Buddhism textualauthority and hegemony of clerical values”(Bjerken, Zeff, 2003). Here shamans are respectedas healers, whose ecstatic experiences make themdifferent from lamas. They are not forced to followthe official orthodoxy of Buddhist lamas.

The Bhutias of Lachen and Lachung areBuddhists and believe in basic principles of meritand sin. They also believe in a vast array of godsand spirits who must be propitiated at appropriatetime for the general welfare of society. The sectthey belong to is Bka’brgyud, the sect whichappears to have been the first school to gain abroad measure of control over western Bhutan. Itwas introduced by its founder Gyal-ba Ha-nang-pa alias Gzibrijid rje (1164-1224) from whom thisschool takes its name. It remained very much afamily interest allied to the important clan of theGiryos which provided its royal abbots. The IHa-Pa, unfortunately, has never come to light inthe records.

Though there are few options for eking out a


living in this environment, but permissible latitudefor deploying surpluses is wide. The use ofsurplus time and resources is not socially orculturally stipulated or economically dictated.Bhutias have a choice in the way they utilise theirsurplus time and resources. They pour theirsurplus time in to religion and the maintenance ofit.

The Bhutias of Lachen and Lachung placegreat emphasis on coercive rites of exorcising anddestroying demons. The execution of religion isin the hands of trained specialists Pau, Nejohumand Lamas. Pau is a male and Nejohum is female.Nejohum wears a Lhasyr (white shawl). Bhutiaspermit its Lamas to marry. One finds both marriedLamas and celibate monks in village. The priestof Bhutias and Lepchas appears to reflect the‘Aris’ of Pagan in some degrees. The Aris-thepriests of Burma were also not strict observer oftheir vow of celebacy; and the basis of theirdoctrines was that sin could be expiated byrecitation of certain hymes. Pau and Lama do notperform rituals simultaneously. Probably no morethan two or three percent of Bhutias of Lachenand Lachung are actually under monastic vows,although many of them have had someinstructions in monasteries, whether as vows, oras full-fledged monks who broke the vows, orsimply as students who took instruction inreading, writing and fundamentals of religion froma Lama. Gomchen (learned Lamas) can be amarried or celibate Lama. Gaylong is a Lama whosticks to celibacy.

Many Lamas are married and stay in the Bustiwith their wives and children. They work in theirfields like ordinary persons when they are not inthe Gompa. They can wear any type of clothes athome, but during ritual festivities they don darkreddish brown long robes and tall red hats trimmedwith gold. Among Bhutias that a householdhaving more boys is in a precarious position infinding brides for the boys. If one boy succeedsanother in birth, he is ordained to become Lama.The household spends the initial expense for hisinitiation, but afterwards he lives on Gompaexpenses and ritual alms.

Lamas do not live in the Gompa all the time.They are present only during festivals andceremonies, or at the times of earning merit foroneself. The Gompa is never closed or empty,there is always a caretaker or Konye who livesclose-by with his family or in a small single quarter.He takes care of the altar, changes fresh water in

the bowls every morning and empties them eachevening. He also keeps butter lamps filled withoil or butter and checks that everything is keptneat and clean. Bhutia nunneries (Manilkhang)are geographically separated from the Gompasand nuns do not perform ritual and funeral ritiesfor the people.

Lachen gompa (1806) and Lachung gompa(1880) are the focus of the kadam-pa/Nyingmasect of the Tibetan Buddhism. There are frequentservices in Busti Gompas, conducted by the localLamas on a variety of ritual occasions at specifiedtimes throughout the year. Such services entailthe construction of complex altar arrangements(destroyed at the completion of event), and thereading of texts, but every service culminates witha distribution of food, for which all the villagerscome. Once a year there is a big festival Losarwhere Lamas dress up in impressive costumesand dance the roles of appropriate gods. All theBhutias attend the Losar, which goes on for threedays and nights.

The ancestral god Pho-Iha (Male god) whosecult reinforces the group’s unity is worshippedbiannually at Chuba-Lhasol in June andDecember four kilometres beyond Lachung.These ceremonies are performed by Lamas on5th or 8th of these months. They reach the placeone day before the actual ceremony to makepreparations. On the appointed day, one male fromeach household gets to Chuba by 8 A.M. toparticipate in the ritual. Twelve Tharzo (religiousflags) with Lha-Gya-Lho (wishing a long life)inscribed on them are hoisted for the better life ofthe people. On Sunday, Tuesday and Thursday,these flags are not raised, if done it brings badluck. At Chuba, there is a holy tree Tha-Gri whichis the abode of the celestial beings. The assembledcrowd shouts “long live” and by 1 P.M. return totheir homes. This ritual is performed for the longlife and stable climate conditions i.e. normal rain,sun and snow. The presence of Pau is essentialfor the yak or pig sacrifice. Nejohum cannot carryout this.

In addition to public Gompa events, villagereligion also consists of privately sponsoredservices, usually held in the sponsor’s home, onthe occasion of birth, marriage, illness and death.A household may sponsor the performance ofceremonies in the absence of any life crisis, simplyfor the purpose of gaining merit, good luck,protection, or all three for the household. Allreligious services have a broadly common base,

68 VEENA BHASIN

centering on offerings and petitions to the gods,and offerings and threats to the demons, andclosing with a distribution of ritual foods to allpresent. Family members worship GoddessYanglahmu for wealth, with gold, butter, milk etc.for one or three or seven days. Each familyperforms this Pooja once in a lifetime. Outsidersmay also participate in this.

The office of Pau and Nejohum is not here-ditary. It is assigned to a person who suddenlystarts showing symptoms of extraordinarybehaviour (aggressiveness, irritation etc.). Theperson goes to Chaam (small house formediation) far away from the village for three yearswith his own provisions. During this period he isforbidden to drink. After three years of meditationhe can start visiting people. Pau performs Poojafor short periods. Chujela, the Pau of Lachen, is65 years old and married with childern worshipsthe Tibetan Goddess Lankoo Thengo. Thisworship is performed for the general welfare ofthe family by burning a hundred butter lamps andchanting verses. For the welfare of the villagePohayah, Ghogenyboh and Rambapoh areworshipped at the time of Dukpasezhi festivalwhich falls around August, at the place ofmigration, Thanggu.

FINDINGS

Disease Incidence

The common diseases in order of theirprevalence in the State are: (1) Hookworm, (2)Scabies, Warts and other skin diseases (3)Malaria, (4) Goitre„ (5) Tuberculosis, (6) Tap-eworms (7) Venereal diseases (8) Roundworm,(9) Other Fevers, (10) Epilepsy and other NervousDisorders (11) Throat Infections and (12) TropicalUlcers. The largest number of patients are listedunder the heading “Other Diseases” in the medicalregisters at various hospitals and dispensaries,which includes a variety of diseases from thecommon cold to pneumonia. The incidence ofthese diseases varies from one zone to another.In North Sikkim diarrhoea and dysentery havehigh incidence. -Helminthes diseases, especiallytapeworm and hookworm; goiter (prevalent inHimalayan region) and venereal diseases are alsowidespread. A number of these are largely water-borne infections which bear a close relationshipto the hygienic conditions prevailing in asettlement. The Lepchas of North Sikkim relish

the carrions of pork, beef, preserved by hangingthem over the fire for a long stretch of time. Thedishes prepared from the semi-decomposedcarrions, not fully boiled, cause enteric disordersand worm infections. Pigs that live on excreta andgarbage are a major factor in the wide prevalenceof this disease.

Health Status of People of Sikkim

The health status of people of Sikkim hasimproved significantly over the last 15 years.Better medical facilities have reduced the infantmortality rate from 88 per thousand in 1988 to 51per thousand in 1997, against the national rate of71 per thousand. The birth rate in 1997 was 19.8per thousand and the death rate was 6.5 perthousand, which is lower than the all-Indiaaverage of 27.2 and 8.9 per thousand respectively.Medical services are free for nearly one and all.

Despite the advances made in health care,there is a need for better family health care. Thechild mortality rate of 32.12 percent is much higherthan the national rate of 11.6 percent (1996). Thedeath rate (22.28) of female child of less than oneyear is much higher than their male counterpart(15 percent). The female/male ratio of 876 is farbelow than India’s ratio of 927. The sex ratio forSikkim deteriorates steadily between the ages of30 and 59 to touch a low of 655in the age group of55-59. The death rate for rural women aged 15-50is very high (43.85 percent) compared to men(23. 67 percent) in the same age group. A majorreason could be a high maternal mortality. No datais available to verify this as natal care is still largelyundertaken by untrained people.

Before its merger with the Indian union in 1975,Sikkim had only one major hospital, which wasestablished in 1917 with 50 beds and three doctorsin Gangtok. In 1979, Sikkim had four hospitals-atSingtam, Gyalshing, Namchi and Mangan, inaddition to the Central Rreferral Hospital atGangtok which began as 50 bed hospital andexpanded to 300 beds with some specialiseddepartments. At present there are 24 PrimaryHealth Centres (PHCs), 147 Primary Health Sub-Centers (PHSCs) and 4 Community HealthCentres in the state. This makes Sikkim possiblythe only state in India to achieve the nationalnorm of establishing 1 primary health centre for2,000 people and 1 PHC for 3,000 people. Asagainst the initial phase of the 1970s, when thesePHCs were grossly understaffed and pharmacists


ran many dispensaries, in the late 1990s, therewere 1-3 doctors and para-medical personnel foreach PHC. All PHCs have electric connectionsand most of them an ambulance. Studies haveshown that the majority of the Sikkimese dependon the PHCs and PHCs for medical care in case ofneed depending on the availability (Bhasin, 1990,1997; Chutani and Gyatso, 1993; Gyatso andBagdass, 1998).

The Lepcha and Bhutia women in north Sikkimlack traditional institutioalised care for pregnantwomen (including a lack of specialised birthattendants). The World Health Organisationdefines a traditional birth attendant (TBA) as aperson who assists the mother at childbirth andwho initially acquired her skills delivering babiesby herself or by working with other birthattendants. Unlike other parts of India where aspecialist (dai) is called in for delivery, althoughnot for a prenatal. The Lepcha and Bhutia womensimply avail the help of experienced women tohelp them with delivery of child. Women deliverat home, with the assistance of older female familymembers or neighbour. Management ofpregnancy is informal, through commonly knownadvice regarding diet and activities, previousexperiences with pregnancy and taking precautionabout evil influence and evil eye.

Disease Perception

Every culture has its particular explanationfor ill health. Culture provide people with ways ofthinking, that are “simultaneously models of andmodels for reality” Geertz (1973). Religion hasbeen held responsible for many differences andnorms affecting the fundamental values andbehavioural pattern in life including healthbehaviour. Every religion has three aspects:values, symbols and practices. The distinctionbetween natural and supernatural exists in allcultures. Lohmann (2003) argues that a super-naturalistic world-view or cosmology is at theheart of virtually all religions. For him the super-natural is a concept that exits everywhere, even ifit is expressed differently in each society. Super-naturalism attributes volition to things that donot have it. On the other hand for Lampe (2003),“supernaturalism” is a problematic and inappro-priate term like the term “primitive”.

In the western world people usually do notmake a distinction between illness and disease.Disease is an objectively measurable category

suggesting the condition of the body. Bydefinition, perceptions of illness are highly culturerelated while disease usually is not. To a greatextent, research in medical anthropology, makeuse of a pragmatic orientation, but a powerfulalternative position also prevails, focusing onnegotiation of meaning as key to understandingsocial life.

Indigenous Disease Theory and Causes ofSickness among Lepchas and Bhutias

The Lepcha and Bhutias’ understanding ofdisease causation, its dynamics and its treatmentsare elements of their culture. Traditional healingcomprises the fundament of knowledge, beliefsand practices, and has existed even after alterna-tives have been provided. Ethnicity comprises aprincipal independent variable the effects ofwhich are analysed with respect to dimensionsof illness episodes and behaviour associated withthe episodes. Illness and misfortunes are distri-buted to a variety of supernatural forces such asattacks by good and bad spirits, witches, sorcerer,forest divinities, spirits of deceased and angrygods and goddesses, breach of taboo and evileye.

For the Lepchas, illness is something that maybe caused by spirits of envy, hatred and quarrell-ing. Illness may be prevented by leading a goodclean life and not causing trouble for others. Thespirits of enmity and jealousy karo-mung causeillness through evil thoughts. If a person isannoyed with a neighbour because his animalshave strayed in his fields or he has done someharm or envies his possessions, this mung isreleased automatically. Illness is caused by evilspirits- Sabdok Loo mung, Dade mung sent byan enemy. It is tried to find out by divination thatwho has released it, but no revenge of any sort istaken. Likewise annoyance or mischiefs ofdifferent mung cause various ailments. Lepchasbelieve that quarreling is the result of the actionsof three evil spirits: su-mung (enmity of speech),ge-mung (enmity of thought), and thor-mung(enmity of action). Besides the evil trinity of so-go-thor, Tamsi mung causes quarrels and wars.Jaundice is caused by the Lon-doon mung. Matmung produces many unpleasant symptomsapparently having no reason are the result of theancestral quarrels. A quarrel annoys deity- GebuTabrong Pano, who afflicts the offenders with allsorts of aches and pains, commencing with

70 VEENA BHASIN

toothache as a punishment. Similarly, theantagonism of rum too punishes people byinflicting them with sickness. The personpossessed by Padam rum, suffers with severebody ache and feels as if he is being poked withbones and sticks. Lepchas consider that peopleborn in different years are distressed by specificmung. For example Lepchas born in Oon nam(sheep year) are troubled by chemen mung, loodesen mung, muzong rumloo and sabdong loo.The persons who are born in antagonistic yearsare troubled by Chemen mung, Loo Desen mung,Muzang Rum Loo and Sabdong mung. The personpossessed by these mung is always hungry and ifcatches sight of people having food, each timeattacks for more food. Lepchas believe that if achild is born with defect or disease, the father ofthe child to be born has executed some immoralact during pregnancy. The death of such a childoccurs in the year corresponding to the month ofpregnancy when the act was carried out and isconsidered the consequence of the endeavor.Accidents, disability, calamity, diseases and lossesare readily explained by holding some elements ofsupernatural or another responsible for.

Bhutias consider that Shinde’s (old man spirit)mischief causes stomachache, miscarriage andother common diseases. Human intervention isalleged source of illness. Bhutias believe thatdiseases can be induced by magic, sorcery andevil eye. Bhutia’s belief in witchcraft and sorceryoffers a possible contrast between the scientificand the cultural reality. They believe they have atleast partially solved the problem, and their partialsolution contributes a great deal towards theshape of the Bhutia cultural system. The varietyof malicious aggressive, violent and unpleasantbeings in the Bhutia world is somewhatoverwhelming. The weight of the system, in termsof sheer number and types, is on the side of evil.

Like Lepchas, Evil eye or nazar is consideredanother cause of sickness among Bhutias as well.People use the eye metaphor to emphasise evilemanating from envious eye-to eye contact. Thescience of parapsychology describes thephenomenon as a type of hypnotism, exercisingsome kind of mind power, which is held by certainindividuals. Causes vary from staring at someonefor a long time, showing admiration or envy,gossiping on a person’s looks, which can havean effect whether it is negative or positive.Compliments are usually believed to be the causeof the Evil Eye. Common symptoms of the Evil

Eye are strong headache, nausea, fatigue orsimply a bad mood. According to believers in thissuperstition, few people, who know the rightprayers and have been trained to deal with thesecases, can only break spells. Practitioners whorelease victims from the spells pass the prayerson to the next generation. They try to cure theevil eye by amulets and charms or holy water,which they procure from religious practitioners.“Curing the evil eye is, therefore, difficult becauseit violates the integrity of the human body andcreates an orifice that attracts other sorts of evil”(Fadlalla, 2002).

It is alleged that certain people can instigatespirit of powerful deities or powerful humans toattack on a living soul indicating displeasure ofthe attacker. These people are supposed to be inpossession of secret evil power, which can beused to instigate malevolent spirit to attack people.These spirits are considered very powerfulbecause they are highly mobile. Sudden illnessafter returning from forest is attributed to Cho-chapshe. Cho-chapshe rites are performed asattempts at outright destruction of the person.Witchcraft is feared even more. Enemies, be theyneighbours or relatives, through their own magicor with the help of a sorcerer, can inflict diseaseand destruction upon others. If the conditionremains undiagnosed and untreated, it can leadto death.

Health Care among Tribal of North Sikkim

Contemporary medical services in Sikkimappears to have been provided by a variety ofpractitioners from domestic, village level healersto monastic healers to primary health services.As Klienman (1980) grouped the healing practicesin to three comprehensive sectors, the Sikkim’shealing practices can be grouped: - (i) professionalsector, which includes biomedicine and amchi(Tibetan medicine); (ii) the folk health care sectorthat includes specialists who are neitherprofessionalised nor bureaucratised; and (iii) thepopular sector includes all the things whichpatient and his relatives do to cure sickness, usingtheir own concepts of what facilitates or delayshealing. An important role is played by oracularor shamanic healers and by amchis andbiomedical practitioners. Treatment could thusbe from herbs, Tibetan pharmacopea and/orwithin the context of magico-religious healingcontained by indigenous framework. Amchi


medicine was officially sanctioned as acomponent of the public health system in Sikkimand given funds for clinical operations andtraining programmes. At the time of field workthere were no amchi in Dzongu.

In 1981, four primary health sub-centres 21child welfare centres were funtioning at Hee-gyathang, Gor, Sakyong-Pentong and Tingbongrevenue blocks. The nearest hospital ordispensary was located at Mangan. In largerbusties (villages) maternity and child welfarecentres were functioning under the supervisionof a child development programme officer. Therewere five child welfare centres in Hee-gyathangand three in Gnon-Samdong, the revenue villagewhere field work was conducted. (the number ofprimary health sub-centres has increased to nineand a primary health centre at Passingdong hasbeen started in Dzongu)

Types of Traditional Healers

Lepchas of Dzongu have an indigenoussystem of health care based on herbs and ritualcare. Lepchas of Hee-gyathang depended moreon Lamas and traditional healers like Mun,bonthing and jhankris (Nepali faith healers) incase of sickness and resorted to primary healthservices only when other means had failed. Thebusties which were close to the health centre,availed of the service more frequently than thoseat a distance.

Herbal Specialists: Who treat people withthe help of herbs available in the vicinity ofDzongu. It seems that no organised Lepcha herbalsystem exists with ‘herbalist’ as professional. Thisis in sharp contrast to the fact that all plants ofthe region are identified, named and thus knownto the Lepchas for a long time. Gathering isindispensable to Lepcha’s economy. It providesthem with important ingredients of their daily diet,medicine and for religious ceremonies. Lepchawith their subsistence economy, depend on theforest for their needs. Among Lepchas of Dzongu,these herbal ‘specialist’ in home remedies aregenerally the elders who do not consider them-selves healers, but suggest and give plantremedies in case of illness. They learnt the secretsof the herbal remedies from their fathers or anyother expert in the required field. Lepcha is natureworshipping community which is also known aslingee. Big trees across the species are tradi-tionally not allowed to be cut down. The herbal

healers who rely on a number of medicinal plantsdo not share the knowledge with others whichhelp in checking reckless exploitation of the plantsby all and at the same time maintain the prestigeof the healer in the society.

The local inhabitants in the North Sikkim areahave inherited rich traditional knowledge of theuse of many plants or plant parts for the treatmentof their common diseases. They often have theinformation on how to use the plants and to takeor to apply the medicine for different diseasesand health care. Information on medicinal uses oftubers, rhizomes or roots used by the inhabitantsof North Sikkim, is presented here. Most peopleabove 50 could identify over 30 types of medicinalplants, whereas younger people would identifybetween 2 and 5 types. Following are some of thelocal plants used in medicine by Lepchas:

Mei-hroom-rik- Juice of the plant is used forsores in mouth and tongue of small babies.

Tuk—rik-koong- Flowers and leaves of theplant are used as vermifuge tonic.

Ka-chuk-koong- Bark and root is used forulcer, bleeding, piles and dysentery.

Sa-naong-koong- Bark is used for diarrhoea.Re-be-rip- Rhizome and leaf paste is used for

eye ailments and cataract.Ruk-lim-koong –Seed, leaf and fruit is used

for rheumatism, paralysis and lumbago.Mongu-tafa/makch-mukh –whole plant is

used for urinary disorders.Naap-saor koong- Bark leaf is used for

chronic diarrhoea and gonorrhoea.Hik-bo-rik-loap –Rhizome of the plant is

used for scabies, itches and stomach troubles.Gye-bookha-noak –ftuit is used as purgative.Ka-look-paot –Fruit cotyledon paste is used

for skin diseases and mumps.De-chyoo-koong –Roots of the plant act as

antidote in of food poisoning.Tung-chaong-maon-rik –Crushed leaves are

used for poultice for sores.Faodjyirip –Bark, leaf and latex is used in case

of acute dysentery.Phachengfea –Crushed tuber paste is used

in wounds and fracture as a bandage.Naong-ryoo-koong – Oil extracted from seeds

is used in curing rheumatism.Dam-Paal-taon-koong –Seeds are taken for

stomach ailments and viral fever.PhozimAeyok –Whole plant is used for

pneumonia and throat pain.Tum-boap-koong –Paste of roots and leaves

72 VEENA BHASIN

in case of gonorrhoea. This has a cooling effect.Num-byaaong-koong – Concoction of bark,

roots and fruit is taken as purgative. It is alsoused in case of inflammation of the vocal chordsto cure hoarse voice.

Ta-kryup-poat –Seeds are used as vermifuge.Tum-baar-koong –Concoction of roots,

leaves and flowers is used for asthma and cough.Pa-go-koong/rip –Papery seeds and bark is

taken for pneumonia and chronic sores.Tuk-fit-rik –Paste of the fruit is used for

toothache and pyorrhoea.Jaringomukh –Tender shoots are taken for

stomach ailments and body pains.Azramon –Paste of leaves is applied as

bandage in case of wounds.Kaon-ke-koong –Pounded bark is applied for

healing in fracture.Al-etok-koond - petals are used for dysentery

and diarrhoea.Khey-gok-koong-leaves are used for chronic

rheumatism; syphills and sciatica.Tung-haer-koong –fruit is used for blood

dysentery.Kaong ge–root, bark and fruit is used in case

of leprosy and other skin diseases.Kachingre-jaeu –fruit is used in case of

pyorrhea.Sa-laong-rip –root is used as poultice in

sprains.Kuntek-rip –whole plant is used for burning

sensation during menstruation; and for tongueblisters

Pushore –root is used for flatulence.Chamm-maa-haa-mukh –root as a remedy

used for suppression of urine;epilepsy andswooning.

Saam-fey-pro –leafy shoots for fracture andbody ache.

Geu-sying –rhizome is used in case ofstomach and liver disease.

Ritual Specialists and Magico-religiousHealer: There are host of illnesses believed tobe caused by evil spirits. These are mostly treatedby ritual specialists or magico-religious healers.He exorcises evil spirits and suggests preventivemeasures against the attack of evil spirits. Charmsand Amulets are also recommended.

Tse-sung are amulets for prolonging life andwarding off dangers.

Rim-sung are worn in time of epidemics.Kunthup-sung are used to ward off general

evil.

Za-sung is a charm for epilepsy patients andis worn in order to prevent attacks.

Sipaha is an amulet for person going in aninauspicious direction and is forced to travel atan inauspicious time.

Palkyet-sung is for good luck.Gyal-sung is charm for warding off the evil

influnences of a special class of demons whichare both inimical and useful to human beings, inproportion to the degree in which they are eitherpropitiated or disregarded. These demons arebelived to be the spirits of perverted lamas, causenight meres, diseases of brain and nervous system.For cases of child birth and various diseases ofnervous system, charms are written on thin stripof paper with chinese ink. These are rolled into apill, coated with butter is administered to thepatient to swallow. In case of difficult labour, theyare tied to the hair of the mother, on the crown ofher head.

Strings of snail-shells are worn around thenecks and writs of children for their protection.

Various plants and herbs are also used asamulets. These plants and herbs have blessedand consecrated at auspicous time of strollinglamas.

Amulets are usually made from a sqaure pieceof Sikkimese Daphne bark (Edgeworthiagardneri) paper. This is folded into a square anddecorated with coloured thread, the inside beinggenerally printed with various spells; usually thename of dieties whose help it wishes to invoke.Other charms are inscribed with scared letters anddiagram copied out of the Tibetan Tantricscriptures. Some charms are worn in silver boxes.These silver boxes are sprinkles by holy waterand are fumigated with incense very morning.Different specified parts of some animals are alsoused as charms.

Certain plants are used in religious cere-monies. Plants with religious significance are: -1.Tuk-ril-koong (Artemisia nilagirica)- theLepchas worship twigs of this plant in all religiousactivities;2. Nanbelli (Lycopodium japonicum)-The bonthing uses this plant in ritual. It isbelieved that this plant helps in exorcising demonswho attack and make people sick; and 3. Pusore(Thysanolaena maxima)- Serrated leaves are usedin religious ceremonies.

It is impossible for an ordinary man to dealdirectly with the spirit world and to know the causeof their annoyance and way of appeasing thedistress causing spirit. Diagnosis and propitiation


is carried out by religious technicians, the mun/bonthing- a medicine man or an exorcist. Mun arenecessary for cleansing from supernaturaldanger, for blessing and solemnising variousundertakings, and for expelling disease causingdevils. Mun cures entirely by rituals and meansof sacrifices. Mun gives no medicine, nor doeshe prescribes the necessary charms and amulets,the making of these being the domain of theLamas. The mun, often but not necessarily afemale shaman, is a healer who exorcises demons,helps to treat illness and guides souls to the nextworld. The mun mediates between human,supernatural and natural. Prior to the introductionof Buddhism in the area, these sacerdotalfunctions were carried by the Lepcha mun. Now,these services are under taken by the yukman orthe Lama as well. The Mun have no socialorganisation. Priesthood is by possession ofsupernatural resident in family lines.Most munceremonies are performed for individuals. Somecalendrical ceremonies are performed togetherwith lamas. For example, Cherim ceremony to avertillness from the community is performed by munand Lama together. Services of mun are veryimportant in the lives of individual Lepchas thanLamas. They (mun) must be present at birth,marriage and funeral

The therapeutic rituals as practiced by ritualexperts and lay persons tend to focus onsymbolically encouraging and assisting theputatively natural course of the sickness or ontransferring it away from the patient’s body, ratherthan on ‘treatment’ or ‘cure’ in specific sense. AtLepchas exorcisms, mun /bonthing traces adouble line of flour from a dough image of demonto the door, as the route it must take to go out.The image is carried accompanied by chantingby a bonthing to the forest or to the place wherefour oads meet with a lighted torch to show theway. Lepcha mun are signified by possession;the ritual consists predominantly in verbalrepetitions; are employed for therapeutic ends;and the people attending ritual play a minimalrole. However, the presence of family and friendsduring the ceremony intensifies the wholeexperience. A patient gains courage throughpublic acceptance of his battle and from knowingthat so many persond are on his side. Co-operationof the patient during exorcism is implied; andsometimes is dramatically expressed. Among theLepchas, the patient himself is an active performer(Gorer, 1937: 206-207). During trance, mun/

bonthing has no need for leaving the body in‘mystical flight’in search of the souls of thepersons who are ill, since most disease is not aresult of “soul loss” but of possession bywandering spirits or demons. The mun/bonthingis possessed by the tutelary spirit who speaksdirectly to the living, diagnose disease and callfor the desired ritual. Certain rituals accompaniedby incantations of verses are performed to invokethe tutelary spirit, which will ultimately possessthe ritual specialist. Many believe that duringpossession, deity/spirit speaks and heals throughthe healer. All therapeutic rituals are accompaniedby lengthy prayers, sacrifices and variousofferings. Twisted pieces of dough (chongbu-tipku) form a part of sacrificial objects in Lamaistceremonies and are usually waved over the personat the end of the ceremony for whose benefit theceremony is performed. Lamas use dough objectas they do not sacrifice. The torma or holy foodis used in every lamaist ceremony. It is high,conical cake of dough, millet paste, butter andsugar and differently coloured. Sacrifice is alwaysperformed by a bonthing. Offerings to devil(Cher-kem) during lamaist ceremonies are madeeither by lay men or lamas. The offering consistingof mixed grains floating in strained chi is thrownon the ground with a wooden spoon to the cry oflo-chi-do (take this). To drive away devils, amystic lamaist ceremony kongso-klon (devildancing) is performed.

Lepchas believe that if some body is possess-ed by Padem rum, the victim feels as if he wasbeing poked with bones or sticks. To appeasePadem rum, services of mun/bonthing aremandatory who sacrifices a fish, a bird, chi (localbeer) along with a scarf, a rupee and a chime. Atthe time of sacrifice, prayers are held to the godof ancestors-Nyou rum for recovery and patientpromises to serve the rum. A person once attackedby Padem rum, perform sacrifice twice a year toremain healthy.

For a person who is born in antagonistic yearand suffering consequently, a Lama andbonthing work together for his recuperation. Lamareads religious books and makes deu (‘a palaceof super naturals’; it is represented by geometricalconstruction of colored threads on a bamboosupport; these thread crosses may be any thingfrom three inches to ten feet high; varies accordingto which lamaist ceremony is performed for) ofChemen Gedo and Lemoo Gedo and set up theseon a pathway. It is mandatory for patient to get

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Loo-fat (sacrifice by bonthing) ceremonyperformed by a bonthing and ceremonies-Goonchen and Sene Kyop by Lamas. Oftenpatient is advices to change his/her name.

Quarrels caused by Tamsi mung affect GeboTabrong Pano deity, who sends all sorts of achesas punishment. To appease the deity, the TyoumaRumsoy (a ceremonial dance in front of a lamaistaltar) ceremony and Kongso klon (devil chasing)ought to be performed. To keep away quarrelsand kill this mung, a piece of paper is stampedwith the printed effigy of mung and surroundedby thirteen crossed sticks. Lamas sit around thispaper holding in their joined hands a phoorbu (asacred dagger, which has three heads on thehandle and a piece of black cloth tied around themiddle). The mung comes in the form of an insect,sits on the paper and is killed with the phoorbu.After the insect has been killed, the insect andpaper are put in the rat’s skull around whichtwelve sut-song (pieces of wood pointed at bothends with a notch in the middle-one end beingred and the other being black) are tied.

To destroy the quarrel causing evil trinity, thedevil so-ge-thor, a lamaistic exorcism ceremonyfeaturing a large image of the demon is performedannually. An archer shoots an arrow so that itpierces the heart of the image. Then the people inattendance tear apart the image, after which theystick bits of it, along with papers with the devil’sname in to a piece of bamboo and burn it. Thiswhole ceremony is accompanied by differentprayers and rituals.

To appease Hlamen Djeme rum , a god whenpleased, a devil when angry, it is necessary toperform the ceremony of Deut Shagu Kyok. Asmall image of the patient made of buckwheatpowder is drawn on the board along with ye, leafcups with grains, arrows and spindles with goldand silver scraping over it. Altar lights (chimi)are lit and lamas read religious books. At the endof the ceremony, the lamas’ pek patient withchongbu tipku and the offerings are removed faraway.

The Go-sum is a strong and potent cure, andis always successful when correctly prescribed.It can be used to cure illnesses caused by thirtydifferent devils; and to negate the effects of evilfortune. To ascertain when a Go-sum is required,Kukzen, a book of Tibetan witchcraft or sorceryis consulted. It is believed that offering of Go-sum will cure the sick Lepcha, provided thediagnose is correct and the disease has been

caused by any one of the thirty demons overwhich it has control. If the recovery of the patientis not seen, It is not due to lack of potency in theGo-sum but to a mistaken diagnosis. The figureof the Go-sum is first built up roughly on a baseof coarse grass and it fastened to a small plankby means of a stick on which it is impaled. Thetrimmings and anatomical details are added laterand are usually made of dough. It has got threeheads, the central is that of bull which is largerthan than the tiger on the right and pig on theleft.

Numbers of precautionary Lamaist and Munceremonies are held regularly to avoid illness.General and regular rituals either held for thewhole community or the obligatory consultationswhich takes place at the beginning of each twelve-year cycle after the third. These remediescorrespond to the special ritual ceremonies heldin the case of illness and misfortunes. In thererituals, lama act as a consultant specialist and thebonthing for the traditional remedies. To keep ingood health, one has to follow certain rules aboutventilation and sunlight and a balanced diet; forthe Lepchas these principles are reinstated bythe worship of the gods and driving away ofdevils. Lepchas perform Lyang Rumfaat- aceremony wherein the deities are called to protectthem from epidemics such as dysertery and otherepidemics that usually affect by the onset ofsummer.

An ox is sacrificed to expel the devil ofjaundice (Lom-doon-mung); and (Mat-mung)who produces various unpleasant symptoms,results of ancestral quarrels.

Exorcism among Bhutias

Bhutia religion includes the primordialtradition of shamanism. By far the most potentmethod of driving out spirits is exorcism - theexpelling of evil spirits through the magic powerof the word. Certain words have to be chanted atthe right moment if the spirit is to yield tomechanical pressure or let it be transferred. Theseincantations can take the form of commands, suchas ordering the spirit to relinquish its host, orappealing to more powerful spirits for intercession.Spells can be cast: that is, words are combined insuch a way that on hearing them a spirit cannotresist them. The ritual of exorcism takes differentforms among different people in India.

In Bhutia religion, after the orthodox


calendrical events, exorcisms rites are highlypopular. In addition to being held annually,exorcisms are also connected with funerals,personal and public problems. The majority ofBhutia rituals are connected with combating thevarious evil beings and the modes of dealing withthem are almost as diverse and numerous as thetypes of evil beings themselves. In one kind ofritual the Bhutias invoke the Pho-Iha (gods),give them offerings and ask them to join theirside in getting rid of offending spirits. When theDeh (evil spirits) see how powerful their side is,they go away. In another kind, evil spirits are askedwhat they need to satisfy them, and their wish isfulfilled. Exorcism also includes threats, forcibleejection and attempts at outright destruction aswell. In exorcism there is always a direct enactmentof conformation with the forces of evil.

The Bhutia shaman is Pau whose primaryfunction is to cure illness. Shamanism in thegreater Tibetan culture has a long and complexhistory. Many of its distinctive ritual forms andbasic functions continued to be appropriated byLamas, wherever they can manage it or by localShamans (Pau). Over the period of centuriesShamanism itself also underwent much change,but it has recognisably survived into the presentamong Bhutias, as a marginal but tenaciousinstitution. However with the introduction ofwestern medicine, it seems to have gone intorather serious decline. There are two Paus, and40 Lamas and 35 Nejohum in Lachung. (SheratchuPau-Pau Sonam, 59 years and Bichchu Pau, PauTensing, 60 years old were believed to bepossessed of many powers.

Pau, Lamas and monks all perform exorcistrituals, that is, rituals involving direct confronta-tion and struggle with evil forces (Deh). Pausand Lamas do similar curing rituals with verysimilar structures, but the Pau work is neverconsidered religious and Lama’s work is notconsidered exorcism. Further, exorcism performedin villages for lay people, by Paus or Lamas, isconsidered lower and must not be attended to bymonks. The only lay village rituals in which monksparticipate at all are funerals, and they leave atthe end of the proper funeral, leaving the villageLamas to conduct the exorcism with which everyfuneral concludes.’ However, every Gampa hasan annual exorcism that is very similar to theannual village exorcism in form and content.Villagers attend the Gompa festivals while monksdo not attend the village festivals.

Bhutia pau (shamans) are capable of seeingspirits in a state of trance. During trance the spiritstake possession of the pau’s body and speakthrough his mouth. The paus are chosen by“visitation”, but unlike other shamans do nottravel to the world of the spirits, but induce spiritsand gods to come and speak through the mouth,diagnose disease and suggest required ritual orsacrifice in order to relieve misery. Whenever apau is approached in case of illness, alleged tobe caused by the mischievous spirit, he tries tofind out the cause. He goes into a trance, andcommunicates with spirits in order to find outwhy they have afflicted the patient with illnessand how to appease them. Sometimes he performsMotapshe (diagnosis) with the help of a Lide(plate) full of Chum (rice). He goes on shakingthe rice plate till the symbol of the evil spiritappears in the plate. The Pau performs Phiphiby offering money, eggs and clothes which havebeen circulated thrice over the patient’s head tothe malignant spirit. These things are thrown out,and only the clothes are brought back. It isbelieved that the person will get cured within threedays. If he is not cured, in that case he goes toLama or primary health centre. This rite is notaccompanied by any sacrifice. If Pau wants tocapture the evil spirit, he will do so by tying thePhetho (thread) round the patient’s arm.

In the patient’s house, the Pau and patient sitin separate rooms. Pau performs Motapshe andafter identifying the evil spirit, walks to patient’srooms with a Khee (knife). Then the Pau performsDakche (knife is heated red hot and licked byPau) and then he carries this heated knife to thepatient and performs Photopashe (blowing offthe hot air near the patient’s body with the knife).Then he drinks Chhang. The whole process takesabout half to one hour.

In case of Shinde’s (old man spirit) mischief,stomachache miscarriage etc. happen. Lamas helpin this by performing Ginse (Havan) for threeconsecutive days in the patient’s house. BigLamas charge Rs. 3000- for this and small Lamastake less.

A Nejohum can treat sterile women andperform Pooja during complicated deliveries. ThePau cannot enter the delivery room though canprovide holy water (Naama) or Ghee (Naachu)for the easy delivery. The presence of Pau andNejohum is not necessary at the time of marriage,naming or funeral ceremonies. If by mistake, Pauenters the delivery room, Thip happens i.e. he

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has committed a sin. Then he cannot visit anyperson for forty days. After this period he performspurification Pooja. The old Pau is called and holywater is sprinkled in the house and outside.

If there are frequent deaths in a family, severeloss of livestock or failures in any sphere of life,Wangchu-chambo goddess is worshipped.Gomchen (learned Lamas) perform this worshipsince it involves long rituals and lore. SometimesLamas from Rumtek and Anche monastery inGangtok are invited for this ritual. This worshipentails various things like Tha (animal blood),Phung-saa (soil sample of the place where a largenumber of people died), Chushiambu (a type offood available in the jungle), Gulang (male genitalorgan made of wood or clay) and Tmgchu. Allthese things are kept in the Chosem (Pooja room)where only the Lama and the head of thehousehold are allowed. All others have to stayoutside. A curtain is put up to prevent the ritualbeing witnessed by mistake. It continues for threeto seven days. On rare occasions it goes on for awhole month. Sepchi (Lama’s assistant) may alsoattend the ritual. The performers take only riceand tea. It is a very expensive ritual, as the peoplewho come to participate (though they sit outside),are to be fed.

The Bhutias of Lachen and Lachung believein Sodimepa (ritual pollution). Those living inthe house where death, delivery or abortion takesplace are considered unclean for three days. Theyare prohibited from joining any ritual or ceremony.

Cho-chapshe rites are performed as attemptsat outright destruction of the person whoembezzles the public funds, or Phipun or Lamawho commits a sin by betraying his public or areresponsible for major thefts in the area. Cho-chapshe is a powerful weapon in which all Pho-lhas (devils) are invoked by the Pau for thedestruction of the offender. While performingCho-chapshe, the name of the offender is writtenon piece of paper (khe chik) and Pau invokes allthe Pho-lhas. All residents gather at the junctionof three streams or rivers. Khe-chik is put in aearthen pot and this pot is placed on three stones(gheepo) with enchanting of special verses forthe destruction of the offender. A fire is lit underthe earthen part and all present stone it. Nobodytouches the broken pot. Then they clap handsthrice and leave for gompa to worship goddessSungma. The Re-tho-goo Phad-heru (the curse)can go up to nine generations. Occasionally, theoffenders vomit blood and die immediately, others

die after some time. It is believed that if Tsiloo, aritual for longevity is performed the blessed personcannot be affected by Cho-chapshe. The first halfof the Cho-chapshe is performed by Pau andsecond by the Lama. He performs a ritual to appeaseSungma (goddess). Pau can come to the Gompabut cannot participate in the ritual in the same waythat the Lama can participate in the Pau ritual. Paugets Rs. 200-300- for Cho-chapshe. In cases wherethe offender is not known, the Cho-chap-she isperformed by writing down that whosoever hascommitted the crime may be punished.

An individual household performs Mindirimi-Khange-So-tangshe for safeguarding itself. Thisritual is performed by small Lamas. It is safeguard-ing ritual and is not meant for outright destructionof the offender, only a little uneasiness for him.Offenders may lose their livestock or sufferdecrease in yield. This ritual is performed in theevening by four people. Some of the soil bearingthe footprints of the offender is brought andplaced where the ritual takes place. Lamas arepaid only Rs. 25/- for this.

In all Bhutia households, in the altar roomamong the religious objects is a wood paddle carvedwith forms of men and animals, the forms are filledwith dough and dried, and are taken out and usedin ceremonie for casting out evil. It saves time tohave a symbol of a devil handy: if any effigy hadto be made each time it would take time. Theceremonies ‘are long and complicated and the figurerepresents a devil which must be exorcised. Thisdough figure is taken out of the house and put atthe cross-roads so that it won’t knew where to go.Figures are never put near anyone’s house.Sometimes, figure made of cloth are also used.

Preventive measures against the attack of evilspirits are also taken. Evil spirits are believed toshun certain colors, metals, or fumes; hence, thesesubstances are used widely to keep evil spiritsaway. Since spirits are believed to avoid black, red,and yellow colors, vermilion is commonly used;they avoid iron, hence, articles made of iron arekept under the head while going to sleep. To wardoff evils-disease causing spirits all households putgosung-a yellow piece of cloth with religiousmantras written on it, on the top of the entrance ofmain doors. In addition to these the prayer flagsand thread crosses are commonly used to ward offthe evil spirits. The lamas are usually consultedfor putting these up. Among Buddhists, thepractice of raising prayer flags and constructingprayer water-wheels is widespread. In Ladakh,


chan, specific kind of paintings with bright andstriking colours are made on the outer surface ofthe walls of the houses as preventive measures.These chan are redone periodically. People hangskull of a goat on the outer wall of the house, framedin small sticks tied together by a twine which istorma obtained at the Losar festival. These arehanged as insurance against sickness. The cornersof the houses are painted red, which successfullybars the admission of the evil spirits.

There are curing ceremonies in which effigiesare destroyed: the effigies can be personificationof the disease demon or even a representation ofan individual who is believed to have infectedthe sponsor of the ceremony with some disease.In some areas, during Losar (New Year) festivalLadakhis celebrate Dosmoche , the great festivalof scape goat. Tormas (effigies made in varioussizes to represent men and demons, replacementsfor human sacrifice which was offered to the godsand demons in pre-Buddhist time)are carried inprocession to open area where a huge creationmade of sticks, tied together by threads hasalready been prepared. At a given moment alltorma are thrown into flames and with theirburning, the sins and diseases of the place areconsumed. After this the erection of the twigs isknocked over and every man makes a mad rushto obtain even a small piece if he can, which iscarried home and placed on one of the outer wallof the house, thus protecting its inmates fromdisease and death. Sikkimese Buddhists alsoemploy complicated mast like structuresconsisting of sticks, threads and tuffs of wool.These structures are known as thread crossesand act as contraptions for catching demons.These objects are put in front of monasteries andvillages to protect them from malignant spirits,who are caught in the set of threads and tuffs ofwool. These contraptions are renewed and theold ones are destroyed after they have servedthe purpose for which they were erected or whenthey become saturated over time with evil spirits(Bhasin, 1990).

Medicinal plants like Digitalis, Primula, Bikma,Panch aunle, Chirato etc are growing at largeextent in Lachung and Lachen area and widelyused by local experts.

Charms and Amulets

Charms and incantations are also used byLepcha-Bhutia to bring about cures of different

diseases. Once the cause of the disease isdecided, the patient consults the practitioneraccordingly. However, before starting thetreatment one may tie charmed amulet for onecannot be always certain of a physical aetiologyof the illness. An amulet (sung-Bo or Ka-Wo) isan object worn or carried on the person, orpreserved in some other way, for magico-religiousreasons, that is, to cure disease, provide luck, orprotect the possessor from specified danger ormisfortune. Enchanted threads or strings of snail-shells are tied round the leg, neck, arm, or waistas a cure for aches and pains. The material ofwhich the amulets are made depends upondifferent factors, one of which is the availabilityof a particular material in the area. Some of thesecharms are Tibetan while others are from Nepalor Bhutan.

University Trained Doctors

Another group of specialists who cater to theneeds of tribals are amchis and university traineddoctors. In communities with strong traditionalhealth care system for managing health, theintroduction of biomedical facilities to providehealth care is often met with indifference (Jefferyet al., 1988). However, among tribals of NorthSikkim occurrence of herbal medicine, ritual cureand other healing resources do not prevent themfrom availing biomedical facilities.

Treatment Strategies

Self or home treatment is usually the first stepin medical care, consisting primarily ofconcoctions of herbs, barks of trees, flowers,roots, leaves, seeds etc. and change in diet.Traditional medical knowledge is coded in tohousehold cooking practices, home remedies; illhealth prevention and health maintenance beliefsand routines. The treatments are known to eldersin the house or neighbourhood or are suggestedby folk therapist. Treatment is generally a familybased process, and the advice of family membersor other important members of a community havea main influence on health behaviour and the formof treatment that is sought.

Indulgence in multiple therapies appears tobe common in prolonged period of illness.However, it is difficult to derive on exact pattern.The strategy a person chooses for the treatmentof his or her illness or that of a relative depends

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on personal experiences and preferences. Thetribal response to health problems reveal amultiple and simultaneous usage of home reme-dies and multiple therapy. The various practi-tioners whose services are sought are spiritist,traditional herbalists and public health practi-tioners. The tribal traditional medical system isbased on personalistic tradition of super naturalhealers and their ministrations and herbalists.The theoretical side of traditional medical system,their religious background, particularly the beliefin the fear of evil spirits, healing performedaccording to spiritual rites explains the persis-tence of indigenous system. These traditionalhealer-diviners operate within a religiousparadigm, with no printed or written material toconform or support the tradition. It is assumedthat these are sanctioned by their religion butwith no proof. This system works on the acceptedpopularity of the individual methods, reputationand performance. The indigenous medical systemhas sustained in society’s social culturalcomplexes through deeply rooted processes. Itis a set of concepts of health and illness thatreflect certain values, traditions and beliefs basedon people’s way of life. It is a “constant processof conformity to contemporary psychologicalneeds with in a recreated cultural identity.”(Wijsen and Tanner, 2001). Levi-Strauss (1967)description of the Shaman and his healingtechniques sheds light on the relationshipbetween process and consequences of healing.The “Shaman provides a language (p. 198) andlike psychoanalyst, allows the conscious andunconscious to merge”. This he achieves througha shared symbolic system and curing of one sickperson improves the mental health of the group.In this context, the patient performs a veryimportant “social function and validates thesystem by calling into play the groups sentimentsand symbolic representation to have them “become embodied in real experience” (pp. 180-182). For these healers, the mind, the body, andthe experiential field are one. The Bonthing/paucan best be understood as a healer of the mindand body as well as community. This is achievedthrough his or her status as the interpreter ofsymbols, those cultural instruments forperceiving and arranging reality. They aresignificant vectors of a force that compels mind,matter and experience (Romanucci-Ross, 1980b).The ritual healers are specialists possessingpower to heal or prevent illness and disaster. It is

believed by tribals that illness emanates from adisjunction of a quasi-equilibrium maintainedbetween man, his environment and the super-natural. An individual or super individual forcecan disrupt the established order. The reestab-lishment of the order or the return to the healthcan only be achieved through a healer or medicineman. The medicine man has recourse to the useof medicinal plants, animal products or minerals.In other cases, he has recourse to rituals with thehelp of which he goes into trance and counteractsthe evil forces. The availability of different healersenables them to switch from one type of healthpractitioner to another in search of the best. Thetribals who can avail the facility of biomedicineor amchi do so without being familiar with thetheoretical principle of medical system. As theeconomic status of the households does not differmuch, they show similarities in their behaviour incase of illness as well. They employ pluralisticstrategies not perceiving any conflict among thesealternatives, nor do they seem to perceive themas different systems, but rather as a variety ofoptions, among which they can choose.

Most usage is sequential but some is simul-taneous. For example, an infant who is being givenprescribed medicine for diarrhoea, may also betaken concurrently to a Bonthing for the evil eyeor given home remedies. Although only indi-genous healers cure certain illnesses such as evileye, this does not preclude the use of biomedicineto treat the symptoms. Gonzales (1966) reportsthat in Guatemalan, the symptoms are treated withbiomedicine, while the cause of illness is dealtwith through a folk specialist. Traditional theoriesof illness aetiology are often multifactorial andmultilevel (i.e. immediate and ultimate levels ofcausation) which permits the use of differenttreatment resources for different causal factorsand levels (Cosminsky, 1977). As reported byCosminsky (1980) for Guatemalan plantation,pluralistic behaviour among tribal populationgroups is pragmatic, often based on trial and error,perceived effectiveness, uncertainty of illnesscausation and expectation of quick results. Inaddition to this empirical and pragmatic behaviour,however, is the role played by faith in the super-natural or spiritual in curing. As a person issimultaneously a body, a self (psyche) and asocial being, so are the healers of the tribals. Asexplained by Adams tribal healers “pursued adialogic, relational remedy for its patients throughreciprocal relationships that encouraged


community, such as in gift giving to spirits andetiologies based on real social conflicts” (Adams,1992: 154). The characteristics of certain ailmentspoints to the cause and mode of action accor-dingly. These “fixed-strategy diseases” (Beals,1980: 194-95) automatically affirm to particular typeof treatment.

In Puerto Rico, spiritism offers a traditionalalternative to community health services. Practi-tioners of ‘espiritsmo’ the major traditional healingsystem in Puerto Rico are mediums that canexorcise illness-causing spirits and assist clientsto acquire enlightened spirit guides and pro-tectors (Koss, 1980, 1987). Spiritism is a multi-functional institution which serves in the PuertoRican as a religion, a voluntary organisation, away of ordering socials relationships, a source ofpersonal identity, and a form of psychotherapy(Harwood, 1977).

In Latin America, particularly in the Andeancountries, there is interdependency of medicalsystems. In a culturally diverse and socially strati-fied population of Latin America, medical systemsconstitutes a social representation resulting fromthe historical relationships between autochtho-nous medical cultures and those from otherlatitudes. “The impregnation of scientific andpopular knowledge results not only in the incor-poration (and often expropriation) of folk inprofessional or scientific medicine, but also inthe increasing ‘medicalisation’ of popularmedicine and traditional therapeutic practices”(Pedersen and Barriffati, 1989). The degree ofcompetitiveness, co-operation or integrationamong medical systems depends mainly onasymmetrical distribution of power and resources,and is conditioned by the population’s behaviourin the management of disease. Ortega (1988)reports that two systems of health care co-existin Ecuador. The traditional system combineselements of the indigenous system, the modi-fications brought by the Incas, and elements ofMedieval European medical theory and practice.The official medical system comprising bothpublic and private institutions is inaccessible forlarge sections of population due to shortages ofmanpower and materials and high cost ofservices.

Khare (1996) in his paper explicates ‘practicedmedicine’ in India and “how India manages notonly multiple traditional and modern medicalapproaches, languages, therapeutic regimens andmaterial medica, but it also leads us to a sustained

moral, social and material criticism from within.The study of such diversity leads to a looselyshared, and ethnographically attestable, culturalreasoning, practice and practical ethos across thetraditional and modern medical worlds” (ibid).Thepluralistic medical situation in tribal areasprovides flexibility and fulfills different needs ofthe population. Among tribals these therapeuticsessions seem to psychologically enablingactions that help tribals overcome the trauma oftheir lives.These sessions serve their functionsand the distinction between empirical reality andimagination is ambiguous. This contrasts sharplywith the closeness of cosmopolitan medicine,which is “discontinuous from ordinary socialprocess” (Press, 1978; Manning and Fabrega,1973) and is unaccommodating to alternativesystems.

A general quantitative survey on the utili-sation of multiple therapy system among tribalsgives an impression that they have inclinationtowards indigenous type. The multiple medicalsystems available to tribals and the optionsavailable to any specific group are many. Mosttribals fail to see little conflict between medicinesand healing rituals. Throughout their lifetime theyhave used the two (the ritual healing and herbaladministrations) simultaneously. In areas wherebiomedical institutions are within the reach of thetribals, they do not hesitate to use the medicinein place of herbal concoctions. Tribals do notfind odd to use ‘medicines’ alongside the ritualsof bonthing/pau. The traditional model is anideology shared by healer and patient.

In view of lack of communication facilities anddistance of health institutions from the busties,medical aid is not availed by tribals except inserious cases. Tribals depend on traditional folk-medicine practitioners, who besides relying uponcertain occult phenomenon deal with variousherbs for preparing medicines for therapeutic use.In these areas people are obsessed with theuncanny, unearthly activities of spirits, ghostsand deities. The disease thought to be caused bysupernatural, demand magico-religious remedy.The tribals resort to various magico-religiouspractitioners for relieving people of death anddisease caused and delegated by the wrathfulsupernatural. Respondents while availing theallopathic medicine report high percentagedistribution of mortality in the present data.However, they fail to mention that allopathicmedicine was taken as a last resort or in terminal

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cases. It was found that deaths reported whileavailing the services of traditional folk prac-titioners was minimum or negligible because thatwas their first choice.

People modify pre-existing practices if theeconomic costs are within their reach. People arepragmatic in trying and evaluating newalternatives. In case of health behaviour the cost-benefit mode of analysis and the empiricalevidence help in deciding, whether it is to theiradvantage or not. There is a change in overtbehaviour of people, but it does not necessarilyexplain or mean changes in the belief system. Inthe study area, it was found that the traditionalbeliefs about fertility, pregnancy and abortionhave remained unchanged though some femalesdelivered their babies at health centre. The tribalsof Sikkim, despite having their traditional medicalsystem strongly supported by beliefs andpractice, were when offered government spon-sored medical services, accepted them and putthese to test even if as a last resort. They do notin all cases continue to use biomedicine, but theyshow open mindedness in trying them out. Thesituation among these tribals is similar to whatWagner found among Navaho. Wagner foundthat Navaho, “have a very open, pragmatic andnondiscriminatory attitude towards variousmagico-religious options available in time of need:White medicine, traditional chant ways, peyotismand even Christian sects on reservation tend tomerge in their minds into alternative and somewhatinterchangeable avenues for being used”(Wagner, 1978: 4-5). Tribals’ acceptance of anyor a combination of these multiple medicalsystems depends on the individual or householddecision. As far as curative medical services areconcerned, these are embraced more easily thanpreventive services, as was seen in case ofimmunisation. Both the groups were not ready toimmunise their children “Cause and effect areeasily comprehended when serious illness giveway to no illness in a few hours or days, causeand effect are less easily seen when, in the caseof immunization and environmental sanitationprogrammes no disease is followed by no disease”(Foster and Anderson, 1978: 245-246). As thereare multiple medical systems available to tribalsto opt for, the course of action to follow dependson the situation and condition of the sick. Thestrategies that underline these decision-makingprocesses have come to be called the “hierarchyof resort in curative practices.” (Schwartz, 1969).

The way in which people formulate their personalhierarchies of resort tell us about theirpreferences.

Among tribals of Sikkim, a sequence of resortdoes not seem to exist; although the trend is tobegin with home remedies to bonthing tobiomedical doctor, as the course of the illnessproceeds and become more serious. However,there is also a back and forth movement betweenresources or a shorten approach, often based onreferrals and advice from relatives and neighboursand other practitioners, which seems to beassociated with desperation over the perceivedincreasing severity of an illness. When a personis sick, he or his family members are primarilyinterested in getting his health restored, for whichthey unhesitatingly combine different treatmentsirrespective of their ontological, epistemic, moraland aesthetic foundation. Medical pluralismresults out of this orientation where attainmentof health is primary objective and the individualis treated in its holistic self. When one system oftreatment fails to provide relief, individual movesonto another and if this treatment fails to providerelief, individual moves on to another and this isindividuals or his group’s choice. In fact it iscustomary, therefore, “for an individual to presenthis symptoms to his relatives and friends for theirappraisal before he takes step to obtain medicaltreatment. The patient alone is not authorized todecide whether or not he is ill, even though hehimself may be convinced that he is sick enoughto warrant special attention, his inmates must stillbe persuaded of the seriousness of his com-plaints” (Foster and Anderson, 1978).

Each medical system is not only a product ofparticular historical milieu and cultural apparatus;it has also its own cognitive categories. Humanbeings caught in illness episodes are lessbothered about the issue of combination; theyare singularly concerned with recovery and relief.For this, distinction between ‘rational’ and ‘non-rational’ methods of diagnosis and treating illnessis abolished. Here the distinction between,‘science’ and ‘faith’ categories collapses; and sois the distinction between magic and religion.Systems of thought and explication, like astrologyand Sufism, which primarily are not medical, areapproached for curative as well as therapeuticpurposes, on the premise that religion is to beresorted in case of suffering, and illness is a kindof suffering, the alleviation of which can besought through prayers, touch invocation of


spirits, sacrifice; libation, appeasing theunfavorable planetary configuration and wearingtalisman and charms on body.

In North Sikkim, there is no medicalisation offolk-medicine by western medicine-the activeattempt by official providers of health care toimpose a standard structure on diagnostic andcuring practices as discussed by Romanucci-Ross of medicine in Italy (Romanucci-Ross, 1997:2) and by Pedersen and Barriffati (1989) forAndean countries. Bio-medical systems as a rulestand in sharp contrast to the indigenous ones,although a study done in Kerala and Punjab hassuggested that there are numerous indigenousmedical practitioners who used western medicine,including penicillin injections (Neumann et al.,1971: 140-141). Despite opening up of PublicHealth Centres and massive propaganda, tradi-tional ideas of disease and health prevail.Bonthing/pau/Lamas cure with prayers andrituals while Amchis cure through the site of thephysical body by means of an elaborate dia-gnostic system and pharamacopeia. It is believedby tribals that traditional medical system iscompetent of restoring health of the body(herbalist) or the mind (bonthing/pau). Amongtribals, the failure of the cure did not call forquestioning the efficacy of the system, but onthe dissonance of ritual behaviour. The totalcommitment of the believers in the traditionalsystem (which is sometimes doubted by failure)persists and so does the belief of the patient inthe healer, regardless of result.

The traditional health care practices are‘patient-centered’ and holistic views of manyfactors meet more effectively the needs of thepatients. Patients’ views about the meaning ofhealth, treatments, the role of emotions and healer-patient communications are important. Widevariety of emotional and spiritual factors haveimpact on tribal health, and that fundamentalchange is required in the way health care isorganised and provided to take full account ofthis. These days’ tribals do not totally rely onritual healers; however they opt for herbalremedies as well. Compared to allopathicmedicines, herbal remedies are cheaper and areeasily available in the vicinity. These herbalremedies are free from side effects many tribalssuffer from after taking the allopathic medicines.In tribal areas of Sikkim, medicinal plants are animportant resource for restoring health. In caseof severe illness, ritual healing is vital alongside

other therapies. Ritual and empiric therapies areintegrated. Phyto-therapeutic treatment may berecommended for the sickness diagnosed by ritualhealers.

It was seen that in tribal areas where both thefacilities (biomedicine and traditional) wereavailable, the tribals often accepted and availedof the biomedical facility. However, side-by-sidethey also performed traditional rituals. Unfortu-nately, adequate medical facilities are not availablein many areas and irony is that the tribals areaccused of not accepting the non-existing medicalfacilities. Biomedicine as provided by PrimaryHealth Centres (PHCs) is generally criticised forfailing to respond to the wider emotional andspiritual needs of the patients. It is like a commo-dity delivered by health professionals and theirassistants. Community members do not participatein its planning, implementation and evaluation. Inareas where public health services are not withinreach, tribals depend on folk and traditional medicalcare, herbs are used as medicines along with ritualsto cure different diseases. The effectiveness of adispensary or a hospital in such conditions isreduced in terms of both area and populationcovered. If medical facilities were located at far offplaces from the settlements, the doctor or nursepopulation ratio would be considerably lower thanthe accepted international norm. However, in somecases efficacy have little or no positive effect onthe productivity of the medical system. Thedependence and confidence on ritual healers isthe result of faith and trust among patients.Through them, the tribals relate their needs tosupernatural powers and ask for assistance andclemency.

The bifurcation between traditional andmodern medical systems still obtains in theanthropological literature, in spite of its erroneousand deceptive representation. All traditionalmedical systems are not irrational and not alikeand even biomedicine has its own tradition. Itwas believed by earlier authors that these twosystems are discrete and biomedicine will replacetraditional medical systems over time (Foster andAnderson, 1978). This study is one of many thatshow that traditional medical practices as well asbiomedicine co-exist. The concept of medicalpluralism relates the existence of more than onemedical system in societies (Leslie, 1979; Elling,1980). As traditional medical system have surviv-ed in this area for such a long time, its therapeuticvalue and what is retainable of traditional system

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and how these can be upgraded through edu-cation, licensing and incorporation in to statehealth planning becomes important. The workforce represented by traditional practitioners andtraditional birth attendants is a potentiallyimportant resource for the delivery of primaryhealth care. In many developing countries,medical doctors are less as compared to traditionalpractitioners. In Ghana, for example, the medicaldoctor/total population ratio is 1: 20,000 comparedto the traditional practitioners/total populationratio is 1: 2,000. Over two-thirds of the births inthe world are delivered by local and traditionalmidwives or births attendants. The traditionalmedicinal care practiced in the area having bothherbal as well as ritual form of curing is notconsidered important by officials. The culturalimportance of ritual cure and role of medicinalplants (their properties as they relate to healing,their symbolic values and their procurement fromenvironment) in the traditional medical system oftribals is of great value. The tribals relate theirritual needs to supernatural powers and ask forhelp and forgiveness. The state sponsoredmedical system do not look “at indigenousmedicine” as a whole and fail to see the socio-cultural basis of its uses.

The main strength of the Traditional MedicalSystem (TMS) of tribals is its capacity to stand aspsycho support system. The explanatory model ofTMS greatly emphasises the notion of disharmonyas a cause due to man’s relations with thesupernatural powers and other bodily connecteddisturbances caused by drinking and eating wrongthings. Transferability and transgressionality ofsupernatural wrath to the members of society makesit a powerful force in social control, a great help inmaintenance of social control.

Tribals epidemiological profile advocate forprovision of preventing services for diseases likegastro-enteric infections, pulmonary infectionsand malaria. These problems have already beentackled in other countries by starting welfare statehealth services. In India too the state healthservices have been functioning but are lesseffective or have overlooked the fact thataggregate health levels cannot improve withoutpreventive measures, such as vaccination andenvironmental sanitation.

DISCUSSION

The ecological conditions in the area dictate

many aspects of traditional life. These areas areplagued by persistent infrastructural constraints.Historical and contemporary social, economic andpolitical processes have helped in creating thepace of development that has been chronicallysluggish. Consequently, often the tribals have toface considerable obstacles, besides being affect-ed by environmental stresses, natural calamitiesand various diseases. Real troubles of Lepcha-Bhutias are not only health or ill-health relatedbut also socio-economic and cultural issues.Their perception of health and illness counts morethan anything, for improving their quality of life.Lepcha-Bhutias still adhere to their faith. Allcultures have shared ideas of what makes peoplesick, what cures them of these ailments and howthey can maintain good health through time. Thiscognitive development is part of the culturalheritage of each population, and from it empiricalmedical systems have been formed, based on theuse of natural resources. There has been a strongcontroversy that should medical anthropologistsuse the concept of culture or abandon it. Theconcept of culture exaggerates the distinc-tiveness, boundedness, homogeneity, coherenceand timelessness of a society’s way of life (Abu-Lughod, 1991). She implies that descriptions areused in terms of practices, discourses, connec-tions and the events of particular people’s life.According to cultural anthropologist Brumannthe problems attributed to the culture conceptare not inherent in the concept, but are a result ofbeing misused. He regards culture as a valuableconcept for communication and one that is validas long as we do not exaggerate the degree towhich learned concepts, emotions, and practicesare shared in a community (Brumann, 1999).

Resources and treatments from differentmedical and religious traditions are being utilisedby the Lepcha and Bhutia of North Sikkim. Thespiritual world of tribal culture exists as a meansof coping with health problems. The widespreadpopularity of religious and non-medical faithhealers bears witness to the fact that people havedeep-seated faith in cures brought through faithhealing. Such people attribute supernaturalcauses to disease and for them it is important toknow whether a particular disease in a patient isdue to the wrath of a goddess, the work of an evilspirit, sorcery, witchcraft, or the breach of a taboo.Once this has been found out, obtaining a cure isa matter of following the advice given by a faith


healer. These beliefs are ingrained in the minds ofindividuals and have become a second habit.Some researchers have tried to elucidate peoples’habits as a conceptual framework for using aspecific medical system or other ways to combatwith illness. Habitus is the mechanism thatconverts objective conditions attached to certainposition in the social structure in to subjectiveaims and motivations in accordance with theprinciple “to make a virtue of necessity”(Bourdieu, 1980, 1986). The issue of healthoriented practices in Bourdieu’s work is shownin statistical terms that the amount of time andmoney which is spent on health caring and bodycultivating activities varies significantly betweendifferent classes. This connection is interpretedas a manifestation of different relations to thebody: ‘the way of treating it, caring for it, feedingit, maintaining it reveals the deepest dispositionof habitus’ (p.190). The habitus theory is even-tually a theory of practical sense that explicatethe logic and reason of daily practices. Socialdifferences in the role of habits in the healthrelated behaviour are defined as non-reflective,repetitive behaviour. The corresponding theo-retical perspective is the habitus theory, thetheory of individualisation, and the habits as therational decision rules. Lindbland and Lyttkens(2002) have mentioned three aspects of habits: -the association between habits and preferences;habits as a source of utility; and the relationshipbetween habits and norms. The habitus theoryaccounts for the logic and reason of everydaypractices. The structure of habitus is engenderedby practices and directed towards the practicalfunctions.

Like other rural parts of India, health care inNorth Sikkim among Lepcha and Bhutia tribalgroups is characterised by medical pluralism.Medical pluralism is the synchronic existence ina society of more than one medicine systemsgrounded in different principles or based ondifferent worldviews. These medical systems arecomplementary, alternative and unconventional.The status, growth and evaluation of co-existingtherapy systems are influenced by culturalideology, ecology, political patronage and chang-ing social institutions. Indulgence in multipletherapies appears to be fairly widespread inprolonged period of illness. However, it is noteasy to derive an exact pattern. Among Lepchasand Bhutias, the health care includes self care,consultation with traditional healers and /or

primary health care. Four systems of treatmentare available to them: herbal; ritual care;biomedicine and amchi medicine beside homeremedies. The State government has introducedbiomedicine and amchi medicine (herbal andmineral tradition of Tibetan Medicine). Thetraditional healers who cater to the needs oftribals are: -specialists in home remedies; ritualcare practitioner (mun, bonthing, lamas amongLepchas and pau and nejohum among Bhutias);herbalists who administer local herbs. Thepsychosomatic treatment in tribal aetiologyincludes appeasement of evil spirits and forcesby sacrifice of animals, by offerings of grains andliquor, use of charms and amulets depicting sacredsymbols. Magical spells are used to divert theundesirable effects of evil spirits.

It was seen that there were no organisedherbal treatment clinics or healers in Dzongu andLachen and Lachung. It is really in contrast withthe information that both Lepchas and Bhutiashave vast knowledge of plants and theirproperties. Lepchas and Bhutias have plantremedies for common ailments. Herbs can beprepared in a variety of forms depending on theirpurpose. Such techniques include: juice squeezedfrom herbs; mashing herbs into a paste; decoctionor extracting the active ingredients by boilingdown the herb in water; hot infusion like hot tea-herb is steeped in hot water. Apart from thesethere are ritual cure specialists (shaman), knownby various names, who treat culture-boundsyndromes. Besides, every household knows howto treat simple problems with the plants availablein their backyards or spices from their kitchens.The pluralistic medical situation of doctors anddeities in tribal areas provide flexibility and fulfillsdifferent needs of the community. The folksystems are open as manifested by eclecticism ofboth the clients and practitioners, who adopt andadapt from an array of co-existing medicaltraditions. This openness of folk systems, asPress (1978) point out, is manifested by theacceptance of inputs from other/alternative healthsystems, and also inputs from institutional sectorssuch as religion and family. According to Landy(1974) the traditional healer role stands at theinterstices religion, magic and social system andgain its power from this position. Tribals do notview these sessions with ritual practitioners asmagical affairs. For them it is the use of spiritualpowers to achieve explicit endeavor by an expertwho manipulates chains of cause and affect for

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the betterment. This is comparable to the classicalanthropological notion of magic as “belief thatsupernatural powers can be compelled to act incertain ways for good or evil purposes byrecourse to certain formulas.” (Haviland, 2003:671).

Two ethnomedical perspectives on illnessand its treatment emerge from the analysis of thedata collected from Lepchas of Dzongu andBhutias of Lachung and Lachen. One dimensionof therapeutic rituals and discourses aboutsickness and body reveals its underlying logic. Itis concerned with cultural construct of sicknessand therapy among lay people and folk healers.Here popular therapeutic rituals are structuredfor certain kinds of sickness. The discourses andpractices concerning of health and sickness areinterwoven in the context of everyday life. TheLepchas and Bhutias have retained their deep-rooted animistic faith and totemic concepts witha high level of superstition in spite of winds ofchange. Among Lepchas and Bhutias religionprovide ethical guidelines for living, for inter-preting natural events including disease, misfor-tunes and disasters. Anything, which can not beexplained pragmatically, is considered super-natural manifestation. The demonolatry religionof the Lepcha-Bhutia is the outcome of theirenvirons. There are cultural, social and psycho-logical conditions that produce and maintainsupernaturalism among Lepchas and Bhutias.Supernaturalism provides the needed explanationas cause of suffering and is emotionallysatisfying. According to super naturalist expla-nation, suffering is caused by evil spirits, evileye, even good spirits if not kept in good moodor neglected or offended unwittingly. Spirits arepropitiated by performing certain rituals accom-panied by animal sacrifice and direct commu-nication in trance by religious technicians. Thesupernaturally caused illnesses are treated byexorcism and appeasement of the spirits. They allhave powers greater than man’s and are harmfulor potentially harmful. The findings of the studyshow that among Lepchas and Bhutias of Sikkimthere is wider tendency of sticking to indigenoustherapeutic practices both herbal and ritual.However, the belief in supernatural causes existsalongside the belief in natural causes as in caseof general health problems and reproductivehealth problems, tribal start with home remediesand herbs. They are familiar with some conditions,which point to the cause, and so the treatment.

Tribal are fastidious about the etiology of thedisease as this is important for therapeuticmeasures. Diagnosis is necessary beforeselecting the right treatment. The diseases thatfollow a particular route of treatment have beendescribed as” fixed-strategy diseases” (Beals,1980).

When a Lepcha priest, bongthing, prescribesmedicinal plants for use, especially in case ofailments such as jaundice, snakebite etc., andrituals are performed and dietary restrictionsrecommended. If traditional medicines do not workin the time expected this is attributed to thedispleasure of God. Propitiation of God throughprayer is the way out. Nowadays modern doctorsare also approached. No one keeps medicinalplants at home because of the belief that theseplants would become the source of the verydisease they otherwise cure. Some medicinalplants are, however, grown by the Lepchainterested in herbal treatments in and around hishome. Most village elders feel the loss of medicinalplants. Some of these used during their childhoodhave disappeared altogether. Possible reasons forthis are assigned to the following factors:population growth, modern development worktaking place in and around the village, diminishingtraditional knowledge, and loss of faith amongstthe younger generation in traditional practices.The measures of conservation suggested includemaking younger people aware of their culturalheritage, keeping the forests untouched, andtaking steps for conserving plants. Older peopledo not even support the idea of marketing theseplants to the outside world for earning revenue.In general, delicate leaves and flowers are bestinfused. Boiling may cause them to lose thevolatile essential oils. Roots, barks, and seedsare best made into decoctions.

The second dimension is spirit possessionand exorcism by shaman. Tribal theory of sicknessdescribes a different source of evil caused byinvisible spirits that exist outside their socialboundaries. These spirits inhabit trees, rivers,lakes, mountains and deserted places around thehabitation. It is alleged that spirits and ghostscause various kinds of suffering and are agentsof illness and fatality. Spirit possession isacknowledged as an illness among Lepcha-Bhutia. When a person starts acting bizarrely ora person has a sickness that does not respond toordinary remedies, tribal consider it as a case forritual cure. Bonthing suspect spirit possession


and makes an effort to force the spirit to revealitself. The system of cause, effect and cure isthus a circular and enclosed system of knowledge.The cause is a spirit, the effect is spirit posse-ssion and the cure is controlled spirit possession.The system of knowledge discloses theunderlying explanation and restrains disorder,chaos and inexplicable circumstances. There is aclose relationship between spirit possession asan altered form of consciousness and parapsy-chology. To believers in spirit possession itprovides a manifest function of the causes andeffects of illness and misfortunes. Possession isa powerful belief system prevalent in many partsof the world. Spirit possession is the concept thatgods, demons, or other disincarnate entities maytemporarily take control of a human body,resulting in notable change in the behaviour. Allspirits are not purely good or evil; the term demo-nic possession is commonly used is when thespirit is malignant. Unlike demonic possessionwhere the person is thought to be taken over bythe devil or his demons for harm, spirit posse-ssion is voluntary, culturally sanctioned displace-ment of personality. The spirits, be they deities,angels, demons or the dead ones are invited toenter a human person. Possession is used toexplain unusual occurrences and behaviour. It canalso explain the failure of a desired result.

The belief in spirits as causing sickness,emanating from witches, has also been reportedfrom multi-caste villages (Berreman, 1964; Harper,1969; Babb, 1975) and in rural areas of Rajasthan(Carstairs, 1985; Lambert, 1992). Comparableobservations have been made from other tribalgroups of Rajasthan (Bhasin, 2002,2003, 2004);Sikkim (Bhasin, 1993, 1997); Himachal Pradesh(Bhasin,1990) and Ladakh (Bhasin, 1997). Spiritpossession as illness has been reported from otherparts of India as well. The basic pattern of theprecipitating event, behaviour during the attack,diagnosis and treatment show extensive range.There are regional differences in the way peoplebehave during an attack; make use of spiritpossession as a mechanism of controlling others;and ascription of wide range of illnesses andmisfortunes under the label of spirit possession.Freed and Freed’s description of the features ofvictims of spirit possession of Shanti Nagar, anorth Indian village near Delhi- shivering,moaning, feeling weak, loosing consciousness,going in to trance and eventually recovering(1964) is different from Opler (1958) account of

eastern Uttar Pradesh in which aggression andthreatened physical violence seem to dominatethe attack. Though, spirit possession among thetribals is non aggressive and is a more generalform of social control than in Shanti Nagar. Likeeastern Uttar Pradesh, spirit possession amongBhutias involves accusation of witchcraft notcommon in Shanti Nagar.

Spirit possession religions and popular ritualsflourish in North Sikkim. Bon, the early religion ofthe area has become like a sect of Lamaism. Mostof the popular sects and shamans involve varietiesof rituals and medium ship. One of the largestand most widespread of the belief systems is thespirit possession ritual, where spirit mediumschannel various gods and goddesses connectedto the tribal group. The ritual specialist enters atrance before becoming possessed by the spirit.The possession usually occurs during religiousceremonies and only lasts during the event.During voluntary possession the mediums donspecific apparel, which facilitates manifestationof the spirit in their bodies. Among tribal of Sikkim,deities and evil spirits possess men as well aswomen. The people initially become possessedby being penetrated by the spirit in the form of anillness. The afflicted tribal come to seek theguidance of the ritual specialists (who themselvesare possessed by various deities) to know(discover) the cause of persistent illnesses, toresolve personal problems, to be relieved ofsorcery spells and possessing demons. Spiritpossession is considered a problem to be remediedthrough the intervention of spiritually possessedritual specialists. “The relationships betweenpeople and the spirits who possess them are thusmetaphors for people’s social, psychological andphysiological conditions” (Danforth, 1982: 60).In certain instances, spirit possession is a methodby which status quo is maintained. Women gaincontrol over their lives within a male-dominatedsociety through the ritual possession of spirit.Demonic possession is, “a culturally constitutedidiom available for women for expressing andmanaging their personal problems” (Nabokov,2000: 71). Possession by familial spirits is acommon occurrence. These spirits usually posse-ss their relatives at moments when ceremonialprotocol at festivals such as marriage, birthceremonies has been breached. The tribal culturesare a part of larger and older traditions that havesought out the healing powers of spirituality.Lepchas and Bhutias go to spiritual healer for

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divination and a ritual for healing and pragmaticpurposes. Spiritual healing serves as one of thefunctions of the spirit possession.

In the tradition of spirit possession, icons aswell as effigies are used to communicate with,and to symbolise good and evil spirits. Theexorcists cast their curses upon small effigies oftheir victims so as to hinder victim’s reproductive,vocal or mobile capabilities. Conversely, mediumsuse effigies to rid people of their demons. In ritualexorcisms, mediums make effigies of the victims,and offer gifts attractive to demons in order tolure them out of the host. Ritual drumming andincantations is a symptom of the trance-like statethe spiritually possessed are in. Cultural historyof the people and their gods and goddesses;myths or powers of any of the goddesses decidewhy or how they choose certain individual tobecome ritual specialists.

The spirit possession and going in to tranceritual, despite it’s outwardly trappings, is generallysought out by petitioners to achieve down toearth goals: -curing of sickness and othermiseries. Trance-like state is indicative of spiritualpossession. The cure involves the intercessionof a spirit that has the power to expel the offendingdemon. The spirits use medium as vessel to helpvictims with their problems caused by demons.Likewise, the victims become vessels forcommunications for the demons. It is duringexorcisms that the victims would enter a trance-like state, and channel the voice of the demons.The supernatural powers are channelisedthrough human hosts. Tribal of Sikkim believethat in cases of possession the cure is notaccomplished by the Shaman- (bongthing andpau among Lepchas and Bhutias of Sikkim ).However these merely act as vehicle of treatment.The shaman enables the divine spirit to come incontact with the spirit, afflicting the haplessvictim. The shaman facilitates the encounter. Thusduring the encounter the exorcist and the victimare very much alike –they are both simulta-neously possessed by an alien spirit. However,there is one important difference. The patient wasdisinclined and taken unaware during his sleep,while attending a funeral or walking under ahaunted tree or any such place. On the contrary,the shaman by virtue of his training andqualifications is in a deeper consciousness andheightened state of awareness and is not as muchof the victim of the possession. His possessionis voluntary and thus a participant in the spirit

world. By vehemently entering this expandedstate, the shaman is able to exercise a limitedcontrol over the spirit. Thus, while it is the spiritand simply spirits that can affect cure, the shamanby virtue of his ability to interact with both theworld of the spirits and world of man is able todirect the consideration of spirit toward thesuffering and sickness caused by possession.Possession is cured by contact with a more power-ful spirits, not by expansion of consciousnessfrom within. This is an adaptive social function,or as described by Spiro (1966: 120), it (spiritpossession) is the basis of social stability inpotentially unstable and disruptive socialcircumstances. It has the similar function thatwitchcraft belief, as described by Evans-Pritchard(1937: 63-83), have for many African societies.The beliefs and institutions surrounding spiritpossession fulfill the function as stated by Spiro(1966: 121) of providing a “culturally approvedmeans, for the resolution of inner conflicts(between personal desires and cultural norms”(cited from Jones, 1976). Powers of strong faith,courage and great patience are the source ofhealing. The ceremonies of visiting the traditionalhealers have established a relationship ofpsychological therapeutic dependence on thepart of the tribals with regard to healers. Thisdependence on the part of the tribals with regardto healer is deeply rooted in their psyche. Medicalsystem’s degree of productivity depends on theeffectiveness of its armamentarium and technicalskills of the practitioners

The empirical reality of such phenomenon isless important in comparison to the connectionbetween occult belief and the social problem. Thisis a question of ‘empirical’ and ‘rationalists’ linkas that between distorted perceptions andtendencies towards scapegoating. The complexi-ty and multiplicity of such phenomenon (humanintervention) is not simple. “Witchcraft and sor-cery are best seen as occupying their own space(seemingly a hyperspace) outside of setframeworks of social or psychological analysis”(Shanafelt, 2004: 329).

The tribal healers of North Sikkim are differentfrom faith healers of Ladakh (Bhasin, 1999) andPhilippines (Chesi, 1981) as they do not performpsychic surgery, ‘bloody operations’, reflexologyand magnetic massage. The Ladakhi Lhama/Lhapa apart from spiritual healing extract thepoison from the patient’ body with the help of ameter long wooden or iron pipe. This pipe is placed


on the suffering part of the body and a stickyblue substance, the considered cause of thesickness is extracted (Bhasin, 1999: 199). ThePhilippines faith healer performs ‘bloodyoperations’, with his fingers and materialises thesubstances that have caused the disease.According to the faith healer, the intensity of histhoughts causes blood to appear between hisfingers and the patient’s skin. Psychic surgeryand bloody operations are two expressions usedby healers to describe intervention in the courseof which they produce materialisation on thesurface of the patient body. Psychic surgery isnot a physical phenomenon, even if the patient’sskin is pierced; it is a spiritual phenomenon(Chesi, 1981: 31). Faith is an important part of it asit is not the healer who affects the actual cure butGod, who uses the healer as an instrument. TheBhopa of Rajasthan are similar to the ‘Bon-thing’and the ‘Mun’ the Lepcha shamans of Sikkim.Both are different from other mediator in the sensethat, these carry out the tasks of the priesthoodas well. In both the groups, while another religionwas either imposed upon or through culturecontact, services of lamas and monks amongLepchas and Brahmin priests among tribals areaccessible, the traditional institution of ‘Bhopa’among tribals of Rajasthan and ‘Bon-thing’ and‘Mum’ among Lepchas of Sikkim carry on (Bhasin,1989). Pau/Nejohum may act as religioustechnicians who make prophesy using grains. Itsperformance is restricted to situations of chronicailments where evil spirits or witchcraft issuspected as the cause of sufferance. Pau/Nejohum acts as intermediary on behalf of peopleand turn into physician cum magician. He is asorcerer who practices magic and magical ritesand offers worship to spirits with whom he issupposed to have a direct link. He drives awaythe evil effects by use of magical spells andcharms, whereas bonthing wards off the dangerby offering worship to gods. As pau/nejohumservices, among Bhutias are sought after in caseof chronic ailments, among Limbus of Sikkim, ricedivination is used for minor aches and pains. Thepatient brings a coin to Yeba (male shaman) orYema (female shaman) and places it in a brassplate. The shaman covers the coin with a handfulof rice. The rice is separated in to small six piles.Four of these piles represent the four directionsand two Limbu deities. The odd and even numberof rice in each pile helps determining the natureof the illness, its cause, its advent and course of

action to be taken. In case of serious illness,Limbus takes clothes of the patient for divinationto the shaman who goes in to trance and spellout the verdict (Bhasin, in press).

Anthropological studies have been carriedout featuring spirit possession (Freed and Freed,1964; Danforth, 1989; Nabokov, 2000). Freed andFreed (1964) discussed spirit possession asillness in Shanti Nagar, a north Indian village nearDelhi. They conceptualised that “spirit posse-ssion is like hysteria and is caused due to theindividual’s intra-psychic tension and a preci-pitation condition due to an event or situationinvolving unusual stress or emotion. The basiccondition of spirit possession is psychological.Danforth (1989) study presents Anastenariareligion of Greece and focuses on the worship ofthe healing power of Saint Constantine. InNorthern Greece, the traditions of Anastenariaare upheld through dancing and fire walking, iconworship and spirit possession. Nabokov (2000)presents a Tamil Nadu study of Southern Indiawhere individuals worship the healing powers ofvarious Hindu goddesses. The Tamils are a mixedgroup consisting of mediums who channel thespirits of the goddesses, and victims who arepossessed by demons. Studies have shown thatmodernity challenges traditional or ritualtherapeutics considering it as superstitioushealing. Kendall’s (2001) study of Koreanshamanism describes how modernity challengessuperstitious healing practices and define themas ancient relics utilised by backward culturalgroups. However, Kendall argues that despite thepower differential, these healing practicescontinue to thrive. (c.f. Wrigley, 2003). Leaderman(2001) has revealed the success of a femaleshaman whose lack of training and willingness toutilise unorthodox healing practices made herdisliked by many traditionalists. However, she stillcontinues to attract a following from all sectionsof society. (c.f.Wrigley, 2003). Harris (2001) studyexplores the implication of shamanism in thepolitics of healing within the Iban of Sarawak inIndonesia, on the cusp between westernanthropological thoughts and the traditional. Heshows the misapprehension of differencebetween members who follow the traditional routeand those who do not. Medical knowledgebecomes the site of that difference and theincorporation of indigenous medical knowledgebecomes part of cultural identity. (c.f. Wrigley,2003).

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Some anthropologists have analysed shama-nism from a functional point of view (Berreman,1964; Mandelbaum, 1964), while Eliade (1964)maintained that shaman’s ecstatic experience is a“primary phenomenon” and is not the result of aparticular historical moment, that is, produced bya certain civilisation. It was fundamental in thehuman condition; and its interpretation andevaluation has changed and modified with thedifferent form of culture and religion. In South-Asia, shamanism has been modified and incor-porated within the cosmology of Hinduism andBuddhism. Among Lepcha-Bhutia, it does not existas a “complimentary” religious rite to Buddhismas was professed by Berreman and Mandelbaumfor their respective studies. Berremen (1964)writing about shamanism in North India comparedthe roles of the shaman with the roles of theBrahman priests and observed that shamans areespecially important as “religious innovators andpolicy makers” (p.53). He profess that priests areadministrators of the “learned, literate or greattradition” (p.55), whereas shamans have directcontact with the supernatural world through apersonal familiar spirit which can possess his bodyand speak through his mouth to communicate withpeople who call upon him for information” (p.56).Shamanism is a necessary and important part ofLepcha-Bhutia religion. Among Lepcha-Bhutias’,in all crisis of life, in case of sickness, death, mis-fortune and rituals accompanied by animal sacrifice,the shamans are indispensable. However, there aresome parts of their religious life that lamas lookafter. Among the Lepchas, during the sanglionceremony that takes place after the death of allLepchas except the lamas, the mun/bonthing(shaman) goes in to trance and during the trance“conducts the soul to the rumlyang where all thedead live” (Gorer, 1937: 359). Lepchas have welldefined idea of the Land of the Dead, where mundescend during possession, which contrastsharply with the lamaistic conception of death andrebirth. The lama believes that the soul wandersfor 49 days and then goes to next reincarnation.During Lepcha funeral ceremonies both the munand lama carry out concurrent but contradictoryrites for the dead.

There are some conditions or specific ill-nesses, which do not correspond to western diag-nostic categories and are restricted to particulararea. Spirit possession as illness is one of these.These diseases have limited distributions aroundthe world due to the fact that unique combinations

of environmental circumstances and culturalpractices cause them. As these conditions do notfit standard psychiatric diagnosis, these aregenerally referred as ‘culture specific diseases’or ‘culture-bound syndrome (McElroyandTownsend, 1989) and can occur among peoplewho share the similar cultural values and beliefs.Some cause relatively minor health problems whileothers are serious and may prove fatal. Forexample, Kuru is a fatal culture specific diseaseof the brain and nervous system that was foundamong the South Fore, people of the eastern NewGuinea Highlands. Hahn (1995) is at variancewith the so called “culture-bound syndrome”. Hecontends that culture-bound syndromes arereductionists’ explanation for certain complexillness conditions i.e., explanations that reducecomplex phenomenon to a single variable. He putsforward that such conditions are like any illnesscondition; they are not so much peculiar diseasesbut distinctive local cultural expressions of muchmore common illness conditions that can be foundin any culture (Hahn, 1995).

Till recently the Lepcha and Bhutia in theseareas were protected from modern influences, theironly contact with outside world being Manganwhere they came form shopping and official workin the District Office. Two decades ago this areawas totally inaccessible due to lesser infras-tructure as compared to present and more officialrestrictions on visiting. Lepcha/Bhutia are movingbetween old and new; adopting new farmingtechnologies while persisting in age-old methodsof ritual care; taking on western styles of dresswhile continuing to wearing traditional dresseson ceremonial occasions; and availing biomedi-cine in conjunction with traditional therapeuticrituals.

Among Lepcha-Bhutia, health issues tend tobe a community issue, decision on treatment areoften taken by a collective since during certainillnesses the entire village observes certain normsand taboos. Certain practices are believed tofacilitate avoiding diseases, while some areprescribed to promote health. It is often allegedthat tribal are so steeped in superstition that theywill not utilise any modern health facility. What isoften not recognised is that inaccessibility isprobably a more important reason than prejudicefor the poor utilisation of health care facilities bytribal. The ritual rites, though take place on specialoccasions, are reflective of the, forces at work insociety. The rituals performed during healing


sessions invigorate the community, the land, andtheir relationships with the gods and the pro-tective deities ensuring their well being. Thera-peutic rituals point out the etnic group’s percep-tions and attitude toward sickness while at thesame time asserting their identity. The comme-moration of identity and cultural roots in ritualsare enabling Lepchas/Bhutias to express theiralienation and cement the internal fissures withinthe community. As already stated, the major ethnicboundary is between the indigenous minoritycomprising Lepcha-Bhutia groups and the migrantNepali groups who constitute the numerical andpolitical majority of democratic Sikkim. Theirnumerical strength and political majority hasgiven Nepali groups an edge over Lepcha-Bhutiagroups over resource entitlements which isaggravating ethnic tension in Sikkim.4 Theseboundaries are being reinforced by religiousdifferences and the contemporary cultural revivalof the Lepcha-Bhutia groups in the region. Thetraditional institution-Dzongubagom amongLepchas has now evolved as Mutanchilomalshezum(Mutanchi- Lepcha; Lom-way; Al-new; Shezum-organisation) and is working as registered societysince 1990. In the Lepcha dialect, the wordspecifies the new way in the changed socio-economic milieu and environment scenario. Theorganisation’s objectives are focused towardssocio-cultural and educational upliftment of theLepchas. Their main aim is to preserve, protectand promote socio-cultural, religious heritage andtraditional healing practices. It has been reportedby Roy Burman (2003) that, “along economicdynamics of ethnicity and no wonder that withthe rise of ethnic fervour a revival and reinforce-ment of traditional medicinal practices are to bewitnessed in Sikkim”. Hunter (2001) argues thatAsian modernity strongly influences the creationand maintenance of cultural identity. She showsthat religious differences and differential under-standings and knowledge affect decision makingin the health arena. The interaction betweenmodernity and convention, through biomedicine,and traditional medicine remains the focus inTibetan Medicine (c.f. Wrigley, 2003). Jones (2001)observed how social organisation in Tibetanmedicine has both absorbed and resisted theinfluence of political changes brought aboutthrough the revolution, but also how traditionalmedicine has not changed its epistemological ortheoretical base during this time. Similarly, amongLepcha-Bhutia, religious paradigm has both

absorbed and resisted the influence of politicalchanges brought about by entry of Nepalese andlater on through annexation with India. Despiteall development efforts of state and centralgovernment these cultural minorities are stillclinging to traditional modes of healing symbo-lising their culture and indigenous knowledgesystems. Samuel (2001) shows the inter-connectedness of the complex nature of thesocial, cultural and politics in the analysis ofhealing praxis. There is relationship between thetraditional and modern in the actual practice ofhealing. There is a difference, between the textualpractice Tibetan medicine and the actualities ofengagement with the individual person. Forexample, Tibetan medicine is textually humoural,but how the practice as carried out is supportedby and imbued with biochemical techniques ofassessment and analysis (c.f. Wrigley, 2003).

Health is produced and eroded in a naturaland social environment that varies in time andspace and according to the social positions ofpeople in different hierarchical, cooperative andcompetitive relationships. Roger’s (1983) innova-tion-diffusion model has provided explanation ofbehavioural changes over time in health pro-motion research. However, the individual choicesand judgments are ultimately determined by theconditions of existence, which are bound to theindividual’s position in the social hierarchy.Nevertheless, early adopters are capable ofproviding social support for behavioural change.Research demonstrates that the majorities do notevaluate an innovation on the basis of scientificstudies of its consequences, but depend on sub-jective evaluation communicated to them by theirpeers (Rogers, 1983). Through the structure ofhabitus, objective life chances are transformedto strategies and turned into subjective innova-tions.

Even though healers may adopt differentmethods, they follow a common working pattern.They identify the name of the illness and itsprobable causes. This wins over the patient’strust. The patient develops a rapport with thehealer and believes he can cure him. The healer’sreputation, the aura created around him, and theequipment he uses - all add to win over thesubject’s confidence. A suitable method ofhealing is selected, keeping the subject’sbackground and symptoms in mind.

Just as a practitioner of allopathy begins withthe history of present illness, so does the

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bonthing start by interrogation. He questions thepatient in order to find out whether he hasintentionally or otherwise broken a taboo; hasbeen disrespectful to a deity; has not cared orprovided for an ancestral spirit; if he has noticedany strange object in the surroundings; has hada quarrel recently with a neighbor, or relative.Emotions and attitudes raised by a physician havea tremendous effect upon the patient. Somedoctors are said to possess a ‘healing touch’. Alarge part of this healing suspects somebodyintends him harm or illness. The ritual healer asksthe patient about his dreams; he interrogatesother family members to find out what they thinkabout the probable cause of the illness; he looksfor omens. The role that faith plays in bringingabout relief or cure is witnessed by practitionersof every system of medicine. Touch dependsupon the doctor’s personality and manner of elici-ting the faith of the patient. The role of faith in aparticular person - be it a priest or a fakir - and hisblessings or medicaments in the cure of a patient,even though the latter may be suffering from aseemingly incurable disease, cannot be denied.

The main function of religion in these socie-ties is to help to cope with the problems of suffer-ing and provide means for receiving relief fromthe suffering. Bhutia rituals primarily serve toinsure that a person will have a long and healthylife and suffer few misfortunes. Bhutia performcuring and purification rites, and maintain similarbeliefs about the supernatural and man’sresponsibility to it. The rites are held to producea harmonious relationship between man and thesupernatural. They also serve as social occasionswhere large numbers of people come together forconversation, drinking and general gaiety. Someof these rites are expensive and the householdmust plan the event and start accumulating theanimals for sacrifice and grains for the feast to beheld. Rituals are social events with super-naturalovertones. Rituals generate a given view of theworld and engender commitment to existing insti-tutional structures and modes of social relation-ship. Rituals restore equilibrium in an unstable orantagonistic situation or validate the status quo.

The process of healing is deeply embeddedin culture. The conceptual consequences ofsickness, diagnosis and treatment and theirinteraction are important in understanding andmanaging sickness. Sickness a fundamentalassault on person and society, is a matter of thedeepest human concern; affecting the life and

death, it can induce deep emotional arousal. Sincehealth care is a constant choice of individuals,their perception of available alternatives and theirmotivation to seek cure is important. The servicesof various practitioners are sought only after thediagnosis has been made. The diagnosis has twotypes of consequences, conceptual and physio-logical. Of course different treatments can havedifferent kinds and degrees of physiologicalconsequences. Not surprisingly, the act of healingoften including intensely dramatic ritual, sharesqualities of the “numinous” in religious expe-rience it can be ineffable, absolute and undeniable(Rappaport, 1979: 211-216). It implies that theexperience of healing can be highly marked. Thepatient experiences some pain and goes to healerfor a diagnosis, who after diagnosis suggeststreatment. The actual representation of metaphorsfor illness and cure act upon to restore harmonyto the disturbed community.

In some societies, medical traditions focus onmaterial causes of ill-health and materialtreatments; in other medical traditions insists onthe spiritual and psychological causes andremedies. In spite of the fact that various typesof inconsistencies between the two systems arecommon, however, among Lepchas and Bhutiasof North Sikkim, there exists an integration ofspiritual and practical understanding of the herbsand healing by local Lepchas and Bhutia amchitradition. Lepcha-Bhutia healing traditions respectboth of these aspects of human nature and theirpotential for supporting health and healing.Lepchas and Bhutias practice pre-Buddhistshamanistic traditions of Bon religion. Sicknesscan be assuaged by adjusting the functioning ofinterdependent causes and conditions by the useof relative means within the realm of relative truth.Lepchas fear spirits causing quarrels, hatred, envyand evil eye as agents of ill-health. The Lepchasare highly tolerant of individual temperamentaldifferences. As long as people are not aggressiveor ambitious, abide by the rules of society andperform their communal duties, their rights arerespected by others. Social control and condem-nation from the group are important forces thatresult in the Lepchas to contain offensive beha-viours and to abide by the rules of the society.Co-operation is very essential in the Lepcha socialorganisation. Lepcha culture suppresses aggre-ssion and competition almost completely. Theonly aggression they exhibit is toward super-natural beings. Conflict between the two people/


households is the concern of the entire busti.Lepchas undertake various strategies to resolvethe conflict. Mutual friends may arrange feast tosolve the problem. If friends fail, than rituals areperformed to exorcise evil spirits that are causingconflicts among the two as Lepchas feel threaten-ed by the fight causing spirits. On ritual failure,the village officials warn the disputants andbecome involved as adjudicators. If even theirmediation appear to fall short, both the partiesare heavily fined and are ordered to host anexpensive feast. Since no one can afford the fineand feast, hostilities are dropped quickly.

The strength of these indigenous medicaltraditions is the fundamental knowledge or ethnomedical concept that is shared by the wholecommunity. It is understood by tribals that a lotof sicknesses have natural causes and naturalcourses and are treated by traditional medicalpractitioners. These traditional practices focusnot only on cure but also on damage control mea-sures as well to ensure speedy and uncomplicatedrecovery. Before starting any type of treatmentone may tie charmed amulets for one cannot bealways certain of physical aetiology of the illness.Tying of a charmed amulet is common preliminaryact that serves two functions (i) if external agentis the cause of disease, the amulets may cure thedisease. The charms also protect the individualagainst demonic interference. The efficacy of theamulets is generally for a limited period. (ii) Anamulet may act as protection even if the cause isphysical manifestation, for spirits can attack aperson in physically weak state.

Traditional or folk medicine is an oral traditionof health care prevalent amongst most tribal andrural communities in India and other parts of theworld. It is a decentralised, autonomous andcommunity supported institution based on localknowledge and resources. Even today, traditionalmedicine is known to cater to the health needs oflarge number of people in developing countries.Political resolve to update the region and open itto outside world has altered social structure anddemographic distribution resulting in erosion oftraditional values and religious beliefs andpractices. In the last 50 years, despite penetrationof biomedicine in remote areas, traditional ideasof disease and therapies prevail.

Indian medical policy is not based ontraditional medicine alone. It is comprehensivelypluralist, since biomedicine, in all its forms, fromhospital based surgery to health centres to

dispensaries is being fully utilised. The integrationof the two systems is conceptual. These systemsjust co-exist side-by-side. The goal of health forall by the year 2000 and the development ofprimary health care have led to increased inter-action between the two systems. Tribal commu-nities in Himalayan districts are in front of arelated dilemma. Their own systems of health careare being replaced by state-sponsored hospitals;primary health centres; private dispensaries andso on. To dismiss traditional medical systems asineffective or weak is to overlook their relevanceand benefits in the contexts of their socioculturalsystems. At the same time the shortcomings ofmodern medical systems: their technical comple-xity, rising costs, curative rather than preventivefocus and limited accessibility for large populationsectors can not be overlooked.

Studies have established that in rural/tribalIndia traditional medical practices as well asbiomedicine co-exist. As traditional medicalsystems have survived here for such a long time,its therapeutic value and what is retainable oftraditional systems and how these can beupgraded through education, licensing and incor-poration in to state health becomes important.The state health programmes are well intendedbut lack anthropological consultation. To date,research into traditional medicine has beencovered mainly by anthropology and it is suggest-ed that other scientific disciplines should beincorporated in order to further rescue and revaluethis part of the cultural heritage that has contri-buted substantially to human health and to thedevelopment of indigenous medical knowledgeand its resources.

In the cases where cultural and social factorserect the barriers to the utilisation of health care,resorting to various intermediation measures maybreak these barriers. It has been reported thatafter the formation of Kerala state, the rapiddecline in infant mortality and fertility rates wasattributed to the intensification of programmeson child and maternal health in these areas sincethen. The establishment of separate women’s andchildren’s hospitals manned by female healthpersonnel is probably a first step in finding asolution to the problems of maternal and childhealth, at least in the initial stages of healthdevelopment in the backward states (Kabir andKrishnan, 1998: 260-61). Long period of schoolingof girls and subsequent high literacy rates alsocontributed to these changes. Education alsofacilitates the training of the medical and

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paramedical personnel from within the region.Health and education should be paired anddeveloped side by side.The important questionis, are the lessons from Kerala’s health transitionrelevant for the tribals of Sikkim? Is the conceptof social intermediation useful in this case?

The economic and social conditions of tribalsare different from the conditions that prevailed inTravencore in 19th century. However, many ofthe factors involved in Kerala’s health transitionare similar to tribals of Sikkim. Like Kerala’s healthtransition, for tribals of Sikkim also, theimprovement in health status entails not onlymedical issues but also economic and socialproblems. While designing a health strategy forthese tribals all these issues need to be tackled.The level of knowledge about causes of illnessand its treatment is of low order among tribals.The main concern of the authorities should be toincrease these awareness levels, so that efficacyof existing services could be significantlyenhanced. The most important need amongtribals is to bring about changes in the socialattitude to biomedicine and health care. Giventhe social environment of the tribal areas, thiscould be achieved by social intervention toovercome social or psychological resistance.

REFERENCES

Abu-Lughod, Lila: Writing against culture. In: RecapturingAnthropology: Working in the Present. Richard G.Fox (Ed.). School of American Research Press(1991).

Adams, Vincanue: Reconstituted relations of productionin Sherpa tourism. Ann. Tourism Research, 19:(1992).

Babb, Lawrence: Heat and control in Chhattisgarh ritual.Eastern Anthropologist, 26: 11-28 (1975).

Beals, A.: Stratigies of resort to curers in South India.Pp.194-195. In: Asian Medical Systems. C. Leslie(Ed.). University of California Press, Berkely (1980).

Berreman, Gerald D.: Brahmanism and Shamanism inPahari Religion. In: Religion in South Asia. E.B.Harper (Ed.). University of Washington Press, Seattle(1964).

Bhasin, V.: Ecology, Culture and Change: Tribals ofSikkim Himalayas. Inter India Publications, NewDelhi (1989).

Bhasin, V.: Habitat, Habitation and Health. A ComparativeStudy of the Peoples of Sikkim and Gaddis ofHimachal Pradesh. Kamla-Raj Enterprises, Delhi(1990).

Bhasin, V.: The human settlements and health status inSikkim. In: People of the Himalayas. K. C. Mahanta(Ed.). Kamla-Raj Enterprises, Delhi (1997).

Bhasin, V.: Medical pluralism and health services inLadakh. J. Soc. Sci., 1: 43-69 (1997).

Bhasin, V.: Tribals of Ladakh: Ecology, Human Settlementsand Health. Kamla-Raj Enterprises, Delhi (1999).

Bhasin, V.: Traditional Medicine Among Tribals ofRajasthan. J. Soc. Sci., 6(3): 153-172 (2002).

Bhasin, V.: Sexual Illnesses and Underutilization ofBiomedicine Among Tribal Women of Rajasthan.Anthropologist, 6(1): 1-12 (2004).

Bhasin, V.: Medical Anthropology: Tribals of Rajasthan.Kamla-Raj Enterprises, Delhi (2005).

Bourdieu, P.: Distinction. A Social Crittque of theJudgement of Taste. Routledge, Great Britain (1986).

Bourdieu, P.: The Logic of Practice. Cambridge PolityPress, Great Britain (1990).

Brumann, Christoph: Writing for culture: Why a successfulconcept should not be discarded. Current Anthroplogy,(Supplement) (1999).

Bjerken, Zeff.: Exorcising the illusion of Bon ‘Shamanism’:A Critical Geoneaology of Shamanism in TibetanReligion. Reveue d’ Etudes Tibetaines, .Number Six-October (2004).

Carstairs, G.M.: Medicine and Faith in rural Rajasthan.In: Health, Culture and Community . D. P. Benjamin(Ed). Russel Sage Foundation (1955).

Charak Samhita, Sutra Sthana, Chapter 1, Shaloka 120-121.

Chesi, Gert.: Faith Healers in Philippines. PerlingerVerlag, Worgi, Australia (1981).

Chutani, C.S. and Gyatso, T. R.: Health Status of Womenand Children in Sikkim. UNICEF, Delhi, p. 30(1993).

Cosminsky, S.: Impact of methods on the analysis ofillness concept in a Guatemalan community. Soc.Sci. Med., 11: 325 (1977).

Cosminsky, S.: Medical pluralism on a Guatemalanplantation. Soc. Sci. Med., 14B: 267-278 (1980).

Danforth, Loring M.: Firewalking and Religious Healing.Princeton University Press, Princeton. (1989).

Doshi, S.L.: Bhils: Between Social Self-awareness andCultural Synthesis. Sterling Publishers, New Delhi(1971).

Eliade, Mircea: Shamanism: Archaic Techniques ofEcstacy. (Bollingen Ser., Vol.LXXVI. PantheonBooks, New York (1964)

Elling, R.: Medical sociology: Traditional and modernmedical system. Special Edition of Soc Sci. Med.,15A(2) (1980).

Evans-Pritchard E.E.: Witchcraft, Oracles and Magicamong the Azande. Claredon Press, Oxford (1937).

Fabrega, H. Jr.: Disease and Social Behaviour: AnInterdisciplinary Perspective. MIT Press, Cambridge,Mass (1974).

Fadlalla, A. H.: Modest Women, Deceptive Jinn: Percep-tion of Foreignness, Danger and Disease Among theHadendowa of Eastern Sudan. HCPDS Working PaperSeries, Volume 12 Number 6 (2002).

Freed Stanley, A and Freed, R.S.: Spirit possession as aillness in a north Indian village. Ethnology, 3(2):152-171 (1964).

Foster, G.M.: Medical Anthropology: Some Contrastswith Medical Sociology. Med. Anthropol. Newsl.,6(1): 1-6 (1974).

Foster, G.M., and Anderson, B.: Medical Anthropology.Wiley, New York (1978).

Geertz, C.: The Interpretation of Culture. Basic Books,New York (1973).

Gonzales, N.S.: Health behaviour in cross-cultural


perspective: A Guatemalan example. HumanOrganization, 25: 122 (1966).

Gorer, Geoffrey: Himalayan Village: An Account of theLepchas of Sikkim. Michael Joseph, London (1938).

Gyatso, T. R. and B. B. Bagdass, B. B.: ‘Health Status inSikkim’, Department of Health and Family Welfare.Government of Sikkim, Gangtok, pp. 33-34 (1998).

Hahn, Robert A.: Sickness and Healing: An Anthropo-logical Perspective. Yale University Press (1995)

Harper, E.B. (Ed.): Religion in South Asia. University ofWashington Press, Seattle (1964).

Harper, E.B.: Fear and the status of the women. SouthWestern Journal of Anthropology, 25: 81-95 (1969).

Harwood, A.: Puerto Rican spiritism, Part 1- Descriptionand Analysis of an alternative psychotherapeuticapproach. Cult. Med. Psychiatry, 1(1): 69-95 (1977).

Haviland, William A.: Anthropology, 10th Edn.Wadsworth, Belmont, CA (2003)

.Janzen, John: The Quest for Therapy: Medical Pluralismin Lower Zaire. University of California Press,Berkely (1978).

Jaspan, M.A.: Traditional Method Theory in South EastAsia. University of Hull, Hull (1969).

Jeffery, P., Jeffery, R. and Lyon, A.: Labour Pains andLabour Power: Women and Childbearing in India.Zed Books Ltd., London (1988).

Jones, Rex L.: Shamanism in South Asia: A PreliminarySurvey.History of Religion. 7(4): (1968).

Jones, Rex L.: Spirit possession and society in Nepat. In:Spirit Possession in Nepal Himalayas. T. Hitchcock,L. Rex and L. Jones (Eds.). Vikas Publishing House,New Delhi (1976).

Joshi, P.: Ethnobotany of the Primitive Tribes in Rajasthan.Printwell, Jaipur (1995).

Kabir, M and Krishnan, T. N.: Social intermediation andhealth change: Lessons from Kerala. In: Health,Poverty and Development in India. M. Das Gupta,Lincoln C. Chen and T. N. Krishnan (Eds.). OxfordUniversity Press, Delhi (1998).

Khare, S.: Dava, Daktar, and Dua: Anthropology ofpracticed medicine in India. Soc. Sci. Med., 43(5):837-848 (1996).

Kleinman, A.: Patients and Healers in the Context ofCulture: An Exploration of the Borderland BetweenAnthropology, Medicine and Psychiatry. UniversityCalifornia Press, Berkeley (1980).

Koss, J.D.: The therapist-spiritist training project inPuerto Rico: An experiment to relate the traditionalhealing system to the public health system. Soc.Sci. Med (Anthropology), 14B(4): 255-66 (1980).

Koss, J. D.: Expectation and Outcomes for patients givenmental health care or Spiritist Healing in PuertoRico. Am. J. Psychiatry, 144(1): 56-61 (1987).

Kothari, G.: Kese honge bhavi pidi ke Bhope (in Hindi).Rajasthan Patrika, (February 14 (1984)

Lambert, Helen: The cultural logic of Indian medicine:Prognosis and etiology in rajasthani populartherapeutics. Social Science and Medicine, 34(10):1069-1076 (1992).

Lampe, Frederick (Fritz) P.: Creating a second storeywoman: Introduced delineation between natural andsupernatural in Melanesia (November 2003).

Landy, D.: Traditional curers under the impact of westernmedicine. Amer. Ethnology, 1: 103 (1974).

Leslie, C.: Medical anthropology: Medical pluralism.Special Edition of Soc. Sci. Med., 14B(4) (1979).

Levi-Strauss, C.: Structural Anthropology. Doubleday, NewYork (1967).

Linda, H. Cnnor and Samuel, Geoffrey (Eds.): HealingPowers and Modernity. Traditional Medicine,Shamanism and Science in Asian Socities. Berginand Garvey. Westport (2001).

Lindbland, Eva and Lyttkens, Carl Hampus: Habits versuschoice: the process of decision- making in health-related behaviour. Social Science and Medicine, 55:451-465 (2002).

Logan, M.H., Hunt, E.E. Jr. (Eds.): Health and the HumanCondition: Perspective on Medical Anthropology.Duxbury, North Scituate, Mass (1978).

Lohmann, Roger Ivar: The Supernatural is everywhere:Defining Qualities of Religion in Melanesia andBeyond. .Anthropological Forum (November 2/003).

Mandelbaum, David G.: Process and structure in SouthAsian religion. In: Religion in South Asia. E.B.Harper (Ed.). University of Washington Press, Seattle(1964).

Manning, P. and Fabrega, H. Jr.: The experiences of selfand body: Health and illness in Chiapas highlands. p.290. In: Phenomenological Sociology. G. Psathas(Ed.), Wiley, New York (1973).

Meharda, B.L.: History and Culture of the Grasias. AdiPrakashan, Jaipur (1985).

McElroy A. and Townsend P.K.: Medical Anthropologyin Ecological Perspective. Duxbury, North Scituate,Mass (1979).

McElroy, A. and Townsend, P.K.: Medical Anthropologyin Ecological Perspective. 2nd Edition. WestviewPress, Boulder, San Francisco, London (1989).

Morsy, S.A.: Gender Sickness and Healing in Rural Egypt.Ethnography in Historical Context. Westview Press,Mueck, M.A, San Fransisco(1993).

Nabokov, Isabella.: Religion Against the Self. OxfordUniversity Press, Oxford (2000).

Neumann, Alferd K., Bhatia, J. C., Andrews, S. and Murphy,A.K.S.: Role of the indigenous medicine practitionersin two areas of India- repot of a study. Soc. Sci.Med., 5: 137-149 (1971).

Opler, Morris, E.: Spirit Possession in a rural area ofnorth India. Pp. 553-566. In: Readers in ComparativeReligion: An Anthropological Approach. A. LessWilliam and Evon Z.Vogt (Eds.), Row Peterson andCo., White Plains, New York (1958).

Ortega, F.: Health Systems and Traditional Medicine InEquador. Dev. Sante, 78: 25-27 (1988).

Pedersen, D and Bariffati, V.: Healers, deities, saints anddoctors: Elements for the analysis of medicalsystems. Soc. Sci.Med., 29(4): 487-496 (1989).

Pordie, Laurent: Panser le monde, penser les medicines.(Dressing the world’s wounds,addressing medicalissues) . Karthala Publishers, Paris (2005).

Press, I.: Urban fold medicine. Am. Anthrop, 80: 71(1978).

Rappaport, R.: Ecology, Meaning and Religion. NorthAtlantic Books, California (1979).

Report on the Administration of the Sirohi State.Government Printing Press, Jaipur (1944).

Rogers, Everett M.: Diffusion of Innovation. Free Press(1983).

Romanucci, R.: On the researching of lost images.Anthropology and Humanism Quaterly, 5(1): 14-20 (1980b).

Romanucci, Ross: Creativity in illness: Methodology,

94 VEENA BHASIN

linkages to the logic and language of science in folkpursuit of health in Central Italy. In: The Anthropologyof Medicine from Culture to Method. Lola Romanucci-Ross, Daniel E. Moerman and Laurence R. Tancredi(Eds.). Bergin and Garvey, Connecticet (1997).

Roy Burman, J.J.: Tribal Medicine. Mittal Publications,New Delhi (2003).

Scheper-Huges, N and Lock, M.: The Mind body, prole-gomenon to future work in medical anthropology.Medical Anthropology, (1978).

Schwartz, L.R. (aka Lola-Romanucci-Ros): The hierarchyof resort in curative practices: The Admiralty Island,Melanasia. J. Health and Social Behaviour, 10: 201-209 (1969).

Shanfelt, Robert: Magic, miracle, and marvels inanthropology. Ethnos, 69(3): 317-340 (2004).

Singh, V. and Pandey, R.P.: Plants used in religion andmagico-religious beliefs in Rajasthan. J. Econ. Tax.Bot., 3: 273-278 (1982).

Spiro, M.: Burnese Supernaturalism. Bobbs-Merrill,Indiapoinlis (1967).

Susrutha Samhitha, Sutra Sthana, Chapter 36, Shaloka 10.Wagner, R.M.: Traditional and modern medicine as

reflected in contemporary Peyotist practices. In:Modern Medicine and Medical Anthropology in theUnited States – Mexico Border Populations. B.Velimirovic (Ed.). Pan American Health Organi-zation, Scientific Publication Paho No. 359,Washington D.C. (1978).

Wijsen, F. and Tanner, R. E. S.: The Recreation of CulturalIdentity. In Press (2001).

Worseley P.: Non-western medical systems. AnnualReview of Anthropology 11: 315-348 (1982).

Wrigley, M.: Review of the book “Healing Powers andModernity. Traditional medicine, shamanism andsocience in Asian societies.” Social Anthropology,11(1): 129-134 (2000).

KEYWORDS Traditional Medical Systems. Health Care Indigenous Systems of Health Care. Tribal. North EastHamlayas

ABSTRACT The knowledge of disease theory and health care system of a society enables us to cope more wisely,more sensitively while introducing new medical system among people who have known traditional system previously.In colonial times, authorities frequently outlawed traditional medical systems. In Ladakh, a traditional medical systemAmchi has been incorporated into health planning. In the traditional medical systems, medical traditions partly coverother sectors of social life. Traditional medical systems therefore cannot be studied exceptionally. In contrast totraditional health care system, the official health care system is based on Western science and technology. The term“Traditional Medicine” or “Traditional Systems of Health Care”, refers to long standing indigenous systems of healthof health care found in developing countries and among indigenous populations. Ethnic medical literature has definedtwo types of Traditional Health Systems-the naturalistic system and personalistic system. Lepchas of Dzongu havean indigenous system of health care based on herbs and ritual care. Spirit possession religious and popular ritualsflourish in North Sikkim. In communities with strong traditional health care system for managing health, theintroduction of biomedical facilities to provide health care is often med with indifference. Traditional medicalknowledge is coded in to household cooking practices, home remedies; ill health prevention and health maintenancebeliefs and routines. The two systems of health care co-exist in Ecuador. Despite opening up of Public Health Centresand massive propaganda, traditional ideas of disease and health prevail. Among Lepchas and Bhutias, the health careincludes self care, consultation with traditional healers and /or primary health care. The cause is a spirit, the effect isspirit possession and the cure is controlled spirit possession.

Author’s Address: Dr. Veena Bhasin, Research Scientist ‘C’ U. G. C., (Professor Grade), Departmentof Anthropology, University of Delhi, Delhi 110 007, India

© Kamla-Raj Enterprises 2007 Anthropology Today: Trends, Scope and ApplicationsAnthropologist Special Volume No. 3: 59-94 (2007) Veena Bhasin & M.K. Bhasin, Guest Editors

medical anthropology: healing practices in contemporary sikkim

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